Blog | Thursday, February 9, 2012

QD: News Every Day--Not all doctors fully disclose errors, pharma ties, bad prognoses

One-third of surveyed physicians did not completely agree that they should disclose serious medical errors to patients, two-fifths said they did not completely agree that they should disclose their financial relationships with drug and device companies to patients, and that one-tenth said in the previous year they had told patients something that was not true.

It seems the patient-centered medical home needs a few small repairs.

Researchers surveyed 1,891 physicians from internal medicine, family practice, pediatrics, cardiology, general surgery anesthesiology and psychiatry nationwide in 2009 to find out if they followed the standards on communication laid out by the American Board of Internal Medicine Foundation’s Charter on Medical Professionalism, which was co-authored by the American College of Physicians. The survey excluded osteopaths, residents and those who practiced in federally owned hospitals.

Results are published in the February 2012 issue of Health Affairs.

Nearly 20% of physicians said they had not fully disclosed an error to a patient in the previous year because they feared the admission would trigger a malpractice case, even though some studies show that prompt communication about an error can reduce anger and make patients less likely to sue.

Other important findings from the survey are:
--More than 55% of physicians said they often or sometimes described a patient’s prognosis in a more positive manner than warranted;
--Women and under-represented minority physicians were significantly more likely to follow the Charter’s provisions than their white male counterparts; and
--More than a third of physicians did not completely agree that they should disclose all financial ties with drug and device makers to patients.

Women were more likely to report never lying, fully describing benefits and risks, disclosing financial relationships, and never having told an untruth in the prior year.

Race or ethnicity was significantly associated with never telling a lie and never disclosing confidential information. In both instances, underrepresented minorities were more likely than white or Asian respondents to report attitudes consistent with charter commitments.

International medical graduates were more likely to respond never lying, never disclosing confidential patient information, and never having revealed confidential information.

General surgeons and pediatricians were most likely to completely agree about needing to disclose all serious medical errors to patients, while cardiologists and psychiatrists were least likely (P less than 0.001). Anesthesiologists, general surgeons and pediatricians were most likely to report never having described patients' prognoses in more positive terms than warranted, while internists and psychiatrists were least likely (P less than 0.05). Cardiologists and general surgeons were most likely to report never having told patients an untruth in the previous year, while pediatricians and psychiatrists were least likely (P less than 0.001).

Physicians in universities or medical centers were more likely to completely agreed with the need to report all serious medical errors than physicians in solo or two-person practices (78.1% vs. 60.5%; P=0.03). Those practicing in regions with the lowest third of malpractice claim rates were more likely to agree that physicians should fully disclose financial ties to drug and device makers compared with physicians in regions with the highest third of malpractice claims (68.9% vs. 60.9%; P=0.40).

And, even though the survey was anonymous, it's likely to underestimate the rate at which physicians do not comply, the authors wrote. The reasons why are more subtle, however.

"The survey results suggest that many physicians do not completely support the charter requirements related to communication with patients. An alternative interpretation is that treating support for the charter precepts as 'black or white'--physicians either do or do not completely endorse and adhere to these principles--fails to recognize complexities of patient physician communication in everyday practice," the authors wrote.

"Despite the relative clarity and unambiguous language of the charter precepts, many factors can affect how and what physicians communicate to patients," they continued. "Some might argue that knowing when to breach or bend these rules-when individual patients require a different approach constitutes clinical wisdom and true patient-centeredness."