Finding Out Your Doctor Made a Mistake
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Institute for Health Policy, Management and Evaluation, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada.
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J Gen Intern Med DOI: 10.1007/s11606-020-06228-9 © Society of General Internal Medicine 2020
errors have become more common as care has M edical become complex. Clinical pathological conferences involving review of autopsy findings, chart reviews and medical audits are older methods of identifying errors in retrospect1. More recently, quality improvement rounds including multidisciplinary perspectives1 and electronic clinical decision support systems have been used to identify and prevent error prospectively. In this issue of JGIM, Bollinger et al.2 describe a new way of uncovering medical error, doing so in the course of conducting research aimed at quality improvement. Pragmatic clinical trials (PCTs), a methodology that is not really new (the polio trial of the 1950s is perhaps the most famous example), are being more commonly performed once again. In the modern version of PCTs, questions can be answered with simple designs like randomizing institutions to one commonly used intervention or another, collecting lots of data about the subjects in each place and then comparing outcomes. In many cases, the interventions being compared are deemed to be so standard that research ethics boards exempt the investigators from obtaining informed consent. In the course of performing the study, medical errors are sometimes inadvertently discovered by the research team, a phenomenon known as “collateral findings”. While the research team may not be required to inform patients that they were subjects in a study (including the fact that someone other than their clinical team was looking at their medical records), they are ethically required to inform those people of the errors, especially when they can be corrected. Bollinger et al. ask an important question: what do patients think about whether and how they should be told about those errors? What are their reactions to this information? Is it welcome? Using a diverse sample of 66 people in 3 cities across the USA, they used a hypothetical example of a PCT that compared 2 strategies for treating hypertension. In the course of doing the research, the investigators discovered that a patient had been placed on a contraindicated combination of drugs that potentially interact in a way that could lead to harm (arrhythmia). They asked the subjects in their study what they
wanted to know, how they wanted to be informed, and who ought to tell them. The key finding was that patients varied considerably in their answers. Some were grateful, some were angry. Some wanted their own doctor (who likely made the mistake) to tell them. Others didn’t trust that person any more so wanted the researchers to tell them. Some wanted to sue. Some wanted lots of information about how the mistake was uncovered. Others didn’t want to know their privacy was being invaded
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