Barriers to medical error reporting and disclosure by doctors: a bioethical evaluation

Abstract

Medical errors that occur in public sector hospitals should be discussed with patients and notified to specific structures to improve systems and patient safety. To elucidate barriers to doctors reporting errors and to establish correct ethical requirements, a mixed methods approach was used. A normative literature-based analysis was done to determine the correct ethical processes taking into account South African legislation. In addition a questionnaire-based internet survey (using REDCap) was conducted at the School of Clinical Medicine (SOCM) at the University of the Witwatersrand which examined the current situation and attitudes towards medical error disclosure. There were 211 clinicians who completed the survey. Public sector hospital staff shortages and patient overloads (96%) as well as poor record-keeping systems (89%) were identified as important reasons for errors. Fears of victimization by colleagues (59%) and medico-legal consequence (56%) were prominent as reasons not to disclose medical errors. Poor reporting systems available to doctors (66%) and insufficient support from senior staff made it difficult for doctors to report errors. Training on correct disclosing of errors to patients and family was seen as necessary to improve skills and facilitate effective disclosure (94%). There was general agreement that doctors 'ought to' disclose harmful medical errors (83%) and to a lesser degree 'potentially harmful' errors to patients (70%). Ethical guidelines that are appropriate for South Africa are suggested, as well as the introduction of easier reporting systems. For disclosure, a safe environment that protects against victimization and medico-legal prosecution is important and legislation to support this is urgently required. Training for doctors in correct methods for adequate disclosure and apology will assist improving patient care.