The downsides of patient safety incident disclosure

We have so far seen that patient safety incidence disclosure has many benefits, but it may also be attended by some risks. Many of these were discussed by Albert Wu and colleagues in their paper titled To tell the truth: ethical and practical issues in disclosing medical mistakes to patients. Some of the potential uncomfortable consequences of disclosure they highlighted were:

    • It ‘may cause alarm, anxiety, and discouragement‘ in patients
    • ‘It may destroy patients’ faith and confidence in the physician’s ability to help them’
    • The patients ‘may become disillusioned with the medical profession in general’ causing them ‘to decline beneficial treatments, or decrease their adherence to beneficial treatment regimens or habits’.
    • It may burden patients ‘with the complexities of their illness’
    • It ‘may cause unwelcome confusion‘ in patients


Munch, Deathbed, detail. William Allen on Flickr.

Disclosure also has potential detriments for the physician, and Wu and colleagues referred to the following impacts:

    • It may be emotionally difficult to do
    • It may provoke anger from the patient
    • It may cause loss of earnings ‘through loss of referrals, hospital admitting privileges, preferred provider status, credentials, and even licensure’
    • It may ‘damage the physician’s reputation through the loss of respect or status among colleagues’
    • ‘The physician’s public reputation may also suffer’ in small communities
    • The physician’s career ‘may be harmed by poor evaluations or letters of recommendation, or even dismissal

Despite these potential negative consequences of disclosure, Wu and colleagues re-emphasised the caregiver’s ‘grave responsibility to avoid harming the patient’ under the principle of non-maleficence, and their obligation to act in their patients’ best interests even if their financial status or professional standing will be compromised by the disclosure.

Shame. frankieleon on Flickr.

In the next post we will look at the investigation of patient safety incidents.

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