Several reasons exist for the disclosure of medical errors that lead to adverse events. First, physicians have an ethical duty to be honest. Second, the disclosure of medical errors is essential for informed consent in future patient care medical decisions. Hence, the disclosure of medical errors will enhance patient trust in physicians. Last, the disclosure of medical errors is important in physician to physician education, which helps prevent future similar events.
Although there is general agreement that physicians should disclose their errors, literature regarding disclosure of another physician’s error(s) remains scarce. Although there is support in the literature to disclose medical errors made by other physicians, several unique barriers regarding disclosure of another physician’s error exist.5,6
One obstacle relates to limited information. The current physician may not have been directly involved in the care of the patient when the error occurred. An error may have contributed to an adverse event, but may not have been the sole cause of the adverse event. Therefore, it may be difficult to establish causal inference in the setting of limited information. Second, given different practice patterns, there may not be agreement on what constitutes an error. Certain practice patterns may be well within the scope of acceptable practice although not representative of personal decision making. Third, there is fear of exposing one’s colleague to malpractice litigation with disclosure of a medical error. Therefore, for many reasons, physicians may avoid disclosing a colleague’s error.
Good communication between physicians is critical in overcoming barriers to limited information and disagreement around what constitutes an error. Physician 2 could initiate dialogue with Physician 1 to distinguish the rationale for continuing alendronate for the duration of Ms. A’s therapy, as well as its continuation following the first AFF. Physician 2 could begin the conversation in a curious and exploratory manner with the goal of determining Physician 1’s medical decision making. The next steps would then depend largely on this discussion’s course and outcome. Physician 1’s decision to treat with prolonged bisphosphonates may have been related to the patient’s fracture risk. Physician 1 may not have recognized the first fracture as an AFF.
Therefore, the first step for Physician 2 is to investigate the course of events further, and this best ensues through direct communication between physicians. Direct communication between physicians also provides an opportunity for physician-to-physician education, mitigating against future similar medical errors.
In the unfortunate situation of determining that an error has occurred, one should disclose the error, even if it involves another physician. The patient has the right to know that prolonged alendronate treatment may have been associated with her first AFF and continuation of the medication may have contributed to the second AFF. Who should be responsible for the disclosure? Gallagher and colleagues suggest that this disclosure decision should take into account many factors including who has the strongest relationship with the patient, who has the best understanding of what happened and its implication for the patient, who is responsible for patient care, and who has the most experience with the disclosure in complex situations.7 If both physicians practice in the same institution, then joint disclosure would be ideal.
