Patients happier when docs discuss side effects

• Public Health • Nov 19, 09

Hospital patients who suffer a side effect from treatment are more likely to give high ratings to their quality of care when hospital staff are up front about what went wrong, a new study suggests.

In a survey of nearly 2,300 patients treated at 16 Massachusetts hospitals, researchers found that 603 had some sort of “adverse event”—most often side effects from a newly prescribed drug or complications from surgery—during their hospitalization.

When asked whether hospital staff had explained the problem to them, only 40 percent of patients said they had.

Yet, when staff did discuss the problem, patients were more likely to be happy with their care—even when the adverse effect was a preventable one, the study found.

“Our findings show that disclosure is associated with patients’ perception of higher-quality care, even when they were harmed by an adverse event,” lead researcher Dr. Lenny Lopez, of Massachusetts General Hospital in Boston, said in a statement.

“We believe this is the first study to address how disclosure affects the quality-of-care impression in patients who actually were harmed during the course of their treatment and may reassure physicians and others who worry about the consequences of disclosure,” he added.

Using hospital records and patient interviews, the researchers found that almost one-third of adverse events in the study were preventable—being related to errors such as giving patients the wrong dose of medication.

Hospital staff were less likely to discuss preventable adverse events with patients compared with ones that could not be avoided—such as an unforeseeable reaction to a new drug. When patients suffered a preventable effect, staff explained the problem to them only 30 percent of the time, Lopez’s team found.

Yet, patients tended to give their care higher quality ratings when a problem was explained to them, even when the complication was preventable.

On average, study patients rated their hospital care as “very good.” But patients who’d discussed their adverse event with hospital staff were twice as likely to give high ratings as those who been given no explanation.

“It’s quite notable that high-quality ratings continued to be associated with disclosure even when the event was determined to be preventable,” Lopez said.

The findings, according to Lopez, suggest that hospitals should not be afraid to disclose the reasons for patients’ adverse events, even if they did arise from error.

“Although rates of disclosure remain disappointingly low,” he said, “our findings should encourage more disclosure and allay fears of malpractice lawsuits.”

“Patients want to be told the truth,” Lopez added, “and they perceive disclosure as integral to high-quality medical care.”

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Lopez and his colleagues report their findings in the Archives of Internal Medicine.

In a separate study published in the same journal, researchers focused on diagnostic errors by physicians. They found that among 300 doctors at 22 U.S. hospitals, the most commonly missed or delayed diagnoses were pulmonary embolism (a blood clot in the lungs), drug reactions and overdoses, heart attacks and lung, colon and breast cancers.

On average, the doctors described committing or witnessing two such errors in their careers. The fact that they readily recalled the details of these cases suggests that “diagnostic error is not unusual in clinical practice,” the researchers write, “and actively soliciting such cases represents an opportunity for tapping into a hidden cache of medical errors that are not generally collected by existing error surveillance and reporting systems.”

SOURCE: Archives of Internal Medicine, November 9, 2009.