The many faces of error disclosure: A common set of elements and a definition

BACKGROUND: Patients want to know when errors happen in their care. Professional associations, ethicists, and patient safety experts endorse disclosure of medical error to patients. Surveys of physicians show that they believe harmful errors should be disclosed to patients, yet errors are often not disclosed. OBJECTIVE: To understand the discrepancy between patients' expectations and physicians' behavior concerning error disclosure. DESIGN, SETTING, AND PARTICIPANTS: We conducted focus groups to determine what constitutes disclosure of medical error. Twenty focus groups, 4 at each of 5 academic centers, included 204 hospital administrators, physicians, residents, and nurses. APPROACH: Qualitative analysis of the focus group transcripts with attention to examples of error disclosure by clinicians and hospital administrators. RESULTS: Clinicians and administrators considered various forms of communication about errors to be error disclosure. Six elements of disclosure identified from focus group transcripts characterized disclosures ranging from Full disclosure (including admission of a mistake, discussion of the error, and a link from the error to harm) to Partial disclosures, which included deferral, misleading statements, and inadequate information to "connect the dots." Descriptions involving nondisclosure of harmful errors were uncommon. CONCLUSIONS: Error disclosure may mean different things to clinicians than it does to patients. The various forms of communication deemed error disclosure by clinicians may explain the discrepancy between error disclosure beliefs and behaviors. We suggest a definition of error disclosure to inform practical policies and interventions.