Mysteries and secrecy surrounding medical errors will soon be a thing of the past if the Quebec College of Physicians and Surgeons has its way. In an unprecedented step, the college has moved to change its code of conduct to require doctors to reveal errors to patients as quickly as possible or face disciplinary action. The amendments are expected to be ratified by Quebec's National Assembly by September.
“The doctors have accepted a more precise definition of their obligations,” said Dr. André Garon, the assistant secretary general, who says that disclosure of errors is the only way they can be understood and prevented. “What we're talking about is sensitizing people to errors so we can target the causes.”
Two weeks after the college's suggested changes were made public in January, the Quebec government followed suit, announcing a plan to reduce the number of medical accidents of all kinds in health institutions, regardless of whether they are caused by doctors, nurses, pharmacists or multiple factors. Hospitals will now be required to inform patients when accidents occur and to explain steps being taken to correct the mishap and prevent similar errors.
Garon, who calls the timing of the health minister's announcement “a happy coincidence,” says error disclosure is not just a question of courtesy, ethics or risk management. “What was implicit in the code before is now explicit,” he said, adding that the transparency is simply a clarification of a doctor's “normal and reasonable duties.” Even if doctors did not make the mistake, they are best placed to inform the patient of any accident or unforeseen complications. “The first responsibility is the physician's, who should be there to explain what happened, what will happen next, and be there to comfort the patient and his family.”
Although being open about medical errors is “absolutely the right thing to do,” physicians shouldn't rush in to blame themselves or colleagues when unforeseen events occur, says Dr. Patrick Croskerry, a Nova Scotia-based clinical consultant in patient safety. Croskerry, who organized a conference on medical error in Halifax last summer (CMAJ 2001;165[8]:1083), says errors can be complex and a “root cause analysis” may be needed to understand them. “You have to take the whole incident apart and look at it from a number of angles,” he explained, and failure to know all the facts should not prevent a physician from telling a patient “something has gone wrong but we don't know yet what caused the problem.”
Croskerry says patients have a right to know about errors and full disclosure is required. “In the past, when there's been a culture of a conspiracy of silence, people were not being realistic about error. But if you bring it out into the open, everyone benefits. Honesty is the best policy.” — Susan Pinker, Montreal