Disclosing Medical Errors to Patients: It’s Not What You Say,
It’s What They Hear
Albert W. Wu, MD, MPH
, I-Chan Huang, PhD
, Samantha Stokes, MPH
, and Peter J. Pronovost,
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;
Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA;
Department of Epidemiology and Health Policy Research,
University of Florida College of Medicine, Gainesville, FL, USA;
Washington, DC, USA;
Department of Anesthesiology and Critical Care
Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
should be told if they are injured by medical care.
However, there is little information on how they react to
different methods of disclosure.
OBJECTIVE: To determine if volunteers’ reactions to
videos of physicians disclosing adverse events are
related to the physician apologizing and accepting
DESIGN: Survey of viewers randomized to watch videos of
disclosures of three adverse events (missed mammogram,
chemotherapy overdose, delay in surgical therapy) with
designed variations in extent of apology (full, non-specific,
none) and acceptance of responsibility (full, none).
PARTICIPANTS: Adult volunteer sample from the gen-
eral community in Baltimore.
MEASUREMENTS: Viewer evaluations of physicians in
the videos using standardized scales.
RESULTS: Of 200 volunteers, 50% were <40 years,
25% were female, 80% were African American, and
50% had completed high school. For designed varia-
tions, scores were non-significantly higher for full
apology/responsibility, and lower for no apology/no
responsibility. Perceived apology or responsibility was
related to significantly higher ratings (chi-square,
81% vs. 38% trusted; 56% vs. 27% would refer, p<
0.05), but inclination to sue was unchanged (43% vs.
47%). In logistic regression analyses adjusting for
age, gender, race and education, perceived apology
and perceived responsibility were independently re-
lated to higher ratings for all measures. Inclination to
sue was reduced non-significantly.
CONCLUSIONS: Patients will probably respond more
favorably to physicians who apologize and accept
responsibility for medical errors than those who do
not apologize or give ambiguous responses. Patient
perceptions of what is said may be more important
than what is actually said. Desire to sue may not be
affected despite a full apology and acceptance of
KEY WORDS: medical error; disclosure; apology; video;
patient perceptions; vignette.
J Gen Intern Med 24(9):1012–7
© Society of General Internal Medicine 2009
There is consensus among professional organizations, ethi-
cists, physicians and the general public that physicians are
obligated to disclose medical errors that cause harm (adverse
events) to patients.
Research suggests that following an adverse event,
patients want an apology, an explanation of what happened
and someone to take responsibility.
appears to fall short of this, with less than a third of patients
even told about harmful errors,
and wide variation
in what physicians choose to disclose.
Few studies have examined the disclosure process or its
consequences for patients. Many patients believe that doc-
tors sometimes withhold information about medical acci-
Patients involved in an adverse event expressed
concern about the occurrence and timing of disclosure, lack
of an apology and inadequate follow-up.
An Internet survey
found that full disclosure may strengthen the patient-
physician relationship and may reduce desire to sanction
A comparison of different methods of disclo-
sure found that full disclosure resulted in greater trust and
satisfaction, and no increased likelihood of seeking legal
Other studies found that patients were more likely
to trust physicians who played an active role in disclosing a
the likelihood of a malpractice claim.
Despite these find-
ings, there are unanswered questions about conducting
disclosure discussions, including how apology and ac-
knowledgment of responsibility affect patients’ and families’
We showed volunteers videotaped vignettes that depicted
physicians disclosing adverse events to patients and surveyed
them on their evaluation of the physicians. We hypothesized
that disclosures that included full apology and acceptance of
Presented in part at the 28th Annual Meeting of the Society for General
Internal Medicine, New Orleans, LA, May 11–14, 2005
Received October 31, 2008
Revised April 30, 2009
Accepted May 29, 2009
Published online July 4, 2009