Patients rate care better if errors are disclosed to them, survey says

Hospital staffers disclose injuries caused by medical care to patients less than half of the time, a new study reports. But when clinicians discuss the adverse events with patients, those patients are more likely to rate their care as better than patients whose caregivers did not tell them.

Researchers led by Dr. Lenny Lopez of Massachusetts General Hospital conducted a telephone survey of more than 2,500 people who had been patients at 16 hospitals in Massachusetts in 2003. Nine months after their hospital stays, 603 people said they had experienced 845 "negative effects" caused by their medical care, including problems with medications or complications from surgery. The authors analyzed the patients' responses, classifying some events as avoidable and others not, such as an unexpected reaction to a new drug.

Only four out of 10 adverse events were disclosed by hospital staff, the survey found. Harm that required additional treatment was more likely to be discussed than other events. Patients were less likely to be told about preventable medical errors than unavoidable problems.

The patients were also asked to rate the quality of their care in the hospital. Patients who were told about adverse events were twice as likely to call their care good or excellent as patients who were not told about them.

"Patients may appreciate being informed about errors in their care and may view disclosure of errors as a signal of high-quality (rather than low-quality) care," the authors write in the Archives of Internal Medicine.

Dr. Robert Wachter of the University of California, San Francisco, said hospitals may have become more open about medical errors in the six years since the survey was done. He also noted that the adverse events and medical personnel disclosures were obtained from patient self-reports, not medical records.

"Notwithstanding these limitations, the article by Lopez and colleagues adds to the accumulating evidence that disclosure is not only ethically correct but, if done well, can lead to higher levels of patient trust, increased perceptions of quality, and perhaps even lower malpractice risk," he writes in an editorial appearing with the article.