Admitting errors doesn't increase lawsuits: study

NEW YORK (Reuters Health) - New research hints that when doctors are open about their mistakes, patients don’t file more lawsuits and the healthcare system doesn’t shell out more money in claims.

While many doctors agree that admitting to medical errors and apologizing to patients is the most ethical way to go, some worry that opening up will make an injured patient more likely to sue.

But researchers who examined the University of Michigan Health System (UMHS) showed that this was not the case, and hope their example encourages more hospitals to go the way of full disclosure.

A code that requires doctors to talk with patients when something goes wrong “allows doctors to be more open about their mistakes,” Dr. Allen Kachalia, the lead author from Brigham and Women’s Hospital in Boston, told Reuters Health. And, “it can help foster trust in the physician-patient relationship,” he said.

Up until about a decade ago, UMHS was like most other large healthcare systems: when a patient got injured, that patient might file a claim and the system either settle with the patient or go to trial. Then, in 2001, UMHS started a new program of admitting all doctor and hospital mistakes, apologizing to patients that had been affected, and offering them compensation.

To see how this program affected hospital costs, Kachalia and his colleagues compared the total number of claims against UMHS, types of claims (lawsuit or not), and the cost of these claims before and after the program was put in place.

With the start of full disclosure, the total number of claims against the hospital decreased and the rate of lawsuits per month was more than cut in half. Total liability costs dropped, with the cost per lawsuit falling from just over $400,000 to approximately $225,000. When patients did file claims, the claims were resolved on average 5 months faster with the disclosure program than before it.

Because there were fewer liability claims overall in the state of Michigan during 2000-2007 than in earlier years, the authors say the results don’t prove that the disclosure program was responsible for cutting costs and decreasing the rate of claims. But the study does show that university hospitals shouldn’t be worried that being honest about errors will blow their budget, Kachalia said.

“We hope that as more institutions see this type of data, that they’ll try and study (disclosure programs), and it will help improve safety down the line,” he said.

The ultimate goal, said Dr. Thomas Gallagher, who studies disclosure of medical errors at the University of Washington in Seattle, is that being more open about errors will help hospitals prevent similar errors from happening again.

While future studies will have to ask patients what they think about having doctors who are open about errors, this paper is an important start to showing the benefits of such openness, Gallagher told Reuters Health.

Doctors “really struggle to communicate effectively in these situations. There’s a lot of shame and embarrassment associated with them,” he said of medical errors. “I think as a first step you need to demonstrate to doctors and hospitals that you can (implement) a program like this and the sky doesn’t fall in.”

Gallagher said that programs similar to the one at UMHS are becoming more common. As the cost of medical malpractice insurance rises and doctors and hospitals try to avoid costly lawsuits while also ensuring that patients are adequately compensated for real errors, full disclosure is one way some healthcare systems are going.

Dr. J. James Rohack, former president of the American Medical Association, said the AMA supports changes in current liability policies - including reform that would take place at the level of the federal government. The AMA also encourages studies of disclosure programs like this one, he said.

Many hospitals aren’t convinced, though, said Dr. Russell Localio, a biostatistician at the University of Pennsylvania who wrote an editorial accompanying the study published in the Annals of Internal Medicine.

“I think a lot of organizations have found it’s much more profitable to lobby for legislation” that protects doctors and hospitals against malpractice claims, rather than being honest about errors, he told Reuters Health. Localio said that more data from other hospital systems, and over a longer period of time, will be needed to get healthcare organizations to shift their focus to open disclosure.

“This is interesting and potentially promising,” he said. The finding “deserves more investigation.”

SOURCE: Annals of Internal Medicine, online August 16, 2010.