Despite efforts by individual physicians and health care systems, medical errors inevitably occur. Errors may range from minor (as in the case of medication dosing errors with no adverse outcome) to severe (as in wrong-site surgery). Estimates of the frequency of such mistakes are high, with a significant proportion of errors resulting in increased hospital stay or producing measurable disability. It is estimated that up to 98,000 people die in the United States per year secondary to medical errors. Disclosure of mistakes is not routine; just 30% of respondents in one national survey who experienced an error in their care reported that they were informed of the error by the involved medical professional. Physicians cite fear of litigation, fear of losing their patient’s trust, fear of having their reputation damaged, and desire to avoid the awkwardness of such a discussion among their reasons for withholding information about medical errors from their patients.

Errors in the field of pediatrics pose unique challenges, as caregivers and not the patients themselves are typically the ones involved in discussions with the health care provider. Attitudes of pediatricians with respect to mistake disclosure have recently been assessed. Although the vast majority of survey respondents supported reporting errors to patients’ families, many identified factors that would deter them. Failure of the patient’s family to understand what they were being told was the most frequently cited of these factors. Most pediatricians feel they would benefit from disclosure training, particularly those still in residency.

Patient attitudes with respect to disclosure of error differ markedly from physician attitudes. Patients define errors much more broadly than physicians do; examples of “medical error” cited by patients included poor service quality and physician rudeness. Physicians, in contrast, defined error solely as deviations from standard of care. Patients unanimously desired that
all errors leading to harm be disclosed and would like to be told everything about the error. Many would additionally prefer to be told about events that nearly led to error, but did not actually result in a mistake. In contrast, physicians felt that all errors causing harm should be disclosed, except if the harm was trivial in nature, if the patient was unable to understand the error, or if the patient did not want to know about the error. Patients also desire compassionate disclosure and an apology from the physician.