Disclosure of Medical Error
A 45-year-old woman returns to theatre on day 3 after laparotomy for perforated appendicitis because of fever, a rigid abdomen and vomiting. Her white cell count is 27 × 10⁹/L with 95 percent neutrophils and creatinine is 87 micromol/L. A retained surgical sponge is found in the peritoneal cavity and removed. Which action by the operating surgeon is most appropriate?
- A.Contact the malpractice insurer before informing anyone else
- B.Disclose the error to the patient and offer an apologyCorrect
- C.Report the scrub assistant to the hospital administration
- D.Withhold the finding to avoid distressing the patient further
Explanation
Honest and prompt disclosure of harmful error to the patient is an ethical and professional obligation grounded in respect for autonomy, veracity and the fiduciary nature of the doctor patient relationship. The patient cannot make informed decisions about her ongoing care, monitoring or possible compensation unless she knows what happened. Recommended practice is to disclose as soon as the facts are reasonably clear, state plainly what occurred, express genuine regret and apologise, explain the consequences and the plan going forward, and describe how recurrence will be prevented. A retained foreign body is a never event and must also be reported through the institutional incident reporting system so that a systems level root cause analysis of counting procedures can be performed. Blaming an individual team member misrepresents what is almost always a system failure of surgical count protocols and undermines a just culture. Concealment compounds the original harm, destroys trust and typically increases rather than decreases litigation risk. Studies of disclosure and apology programmes show reduced claim frequency and faster resolution. Legal advice may follow, but it never precedes the duty of candour to the patient.
Why each option
- A.
- Seeking legal advice may be reasonable later, but it must never take precedence over informing the patient about harm she has suffered.
- B.
- Correct. Full, timely disclosure with apology respects patient autonomy, fulfils the duty of candour and is associated with lower litigation risk.
- C.
- Individual blame ignores the system failure in the surgical count and conflicts with a just culture approach; incident reporting is not the same as scapegoating.
- D.
- Concealment violates veracity and autonomy, deprives the patient of information she needs, and worsens both trust and legal exposure.
Reference: Gallagher TH, Studdert D, Levinson W. Disclosing harmful medical errors to patients. N Engl J Med 2007;356:2713-2719.
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