Medical error: disclosure and apology
- Procedure
When an error affects the patient, the doctor tells them honestly, explains what happened, apologises and says what will be done.
What it is
All doctors make errors, and most are not due to negligence: incomplete knowledge, lapses of judgement or attention, fatigue and the work environment all play a part. The duty of truthfulness includes disclosing errors that affect the patient; in general, even minor ones. Patients nearly always want the error acknowledged, and honesty tends to reduce, not increase, lawsuits. Withholding an error needs an ethical justification reviewed by another doctor or the ethics committee.
How it is done
- Care for the patient first: correct or limit the harm.
- Prepare the conversation with the known facts; agree with the team who will speak.
- Talk soon, in private, with the patient and, if they wish, their family.
- Explain in plain words what happened and its consequences, without speculating or blaming others.
- Express regret and apologise sincerely.
- Explain what will be done for the patient and to prevent it happening again.
- Record the conversation in the medical record and report the event under the institution's policy.
- Offer follow-up and a contact for further questions.
In clinical practice
- A minor error without harm (a delayed dose that was corrected) is also disclosed, simply.
- If a colleague made the error and does not disclose it, encourage them; if they refuse and the error is serious, escalate to a supervisor.
- Before taking the case further, make sure of the facts.
- The doctor who makes an error also needs support; talking about it reduces burnout.
Common mistakes
- Waiting for the patient to find out about the error some other way.
- Giving technical or vague explanations to hide what happened.
- Blaming other team members in front of the patient.
- Promising results or compensation that the doctor does not control.
- Not recording the conversation.
Test yourself
Think of the answer, then tap the question to see it.
Should minor errors that caused no serious harm also be disclosed?
In general yes; withholding any error needs an ethical justification reviewed by another doctor or the ethics committee.
Does honest disclosure of an error raise the risk of being sued?
Not necessarily: patients sue less when they feel they were told the truth, and many lawsuits seek to force that conversation.
What should you do if a colleague made a serious error and does not disclose it?
First encourage them to disclose it; if they refuse, and after confirming the facts, take it to a supervisor or decide how to inform the patient.
What does a good disclosure conversation include?
What happened, its consequences, a sincere apology, what will be done for the patient and to prevent recurrence, and a follow-up plan.
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Mistakes (University of Washington, Department of Bioethics & Humanities, 2018); Truth-telling and Withholding Information (University of Washington, Department of Bioethics & Humanities, 2018); Ley 23 de 1981, por la cual se dictan normas en materia de ética médica (Función Pública, Gestor Normativo, 1981).
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Representative model, for educational purposes only.