NOTE: The UW Dept. of Bioethics & Humanities is in the process of updating all Ethics in Medicine articles for attentiveness to the issues of equity, diversity, and inclusion.  Please check back soon for updates!


Douglas S. Diekema MD, MPH, Adjunct Professor, UW Dept. of Bioethics & Humanities

Core clerkship material for: Internal Medicine | Surgery



Topics addressed:

  • How do mistakes occur?
  • Do physicians have an ethical duty to disclose information about medical mistakes to their patients?
  • How do I decide whether to tell a patient about an error?
  • Won't disclosing mistakes to patients undermine their trust in physicians and the medical system?
  • By disclosing a mistake to my patient, do I risk having a malpractice suit filed against me?
  • What if I see someone else make a mistake?

Errors are inevitable in the practice of medicine. Sometimes these result from medicine's inherent uncertainty. Occasionally they are the result of mistakes or oversights on the part of the individual provider. In either case, a physician will face situations where she must address mistakes with her patient.

How do mistakes occur?

All physicians make mistakes, and most mistakes are not the result of negligence. A physician may make a mistake because of an incomplete knowledge base, an error in perception or judgment, or a lapse in attention. Making decisions on the basis of inaccurate or incomplete data may lead to a mistake. The environment in which physicians practice may also contribute to errors. Lack of sleep, pressures to see patients in short periods of time, and distractions may all impair an individual's ability to avoid mistakes.

Do physicians have an ethical duty to disclose information about medical mistakes to their patients?

Physicians have an obligation to be truthful with their patients. That duty includes situations in which a patient suffers serious consequences because of a physician's mistake or erroneous judgment. The fiduciary nature of the relationship between a physician and patient requires that a physician deal honestly with his patient and act in her best interest.

How do I decide whether to tell a patient about an error?

In general, even trivial medical errors should be disclosed to patients. Any decision to withhold information about mistakes requires ethical justification. If a physician believes there is justification for withholding information about medical error from a patient, his judgment should be reviewed by another physician and possibly by an institutional ethics committee. The physician should be prepared to publicly defend a decision to withhold information about a mistake from the patient.

Won't disclosing mistakes to patients undermine their trust in physicians and the medical system?

Some patients may experience a loss of trust in the medical system when informed that a mistake has been made. Many patients experience a loss of trust in the physician involved in the mistake. However, nearly all patients desire some acknowledgment of even minor errors. Loss of trust will be more serious when a patient feels that something is being hidden from them.

By disclosing a mistake to my patient, do I risk having a malpractice suit filed against me?

It has been shown that patients are less likely to consider litigation when a physician has been honest with them about mistakes. Many lawsuits are initiated because a patient does not feel they have been told the truth. Litigation is often used as a means of forcing an open and honest discussion that the patient feels they have not been granted. Furthermore, juries look more favorably on physicians who have been honest from the beginning than those who give the appearance of having been dishonest.

What if I see someone else make a mistake?

A physician may witness another health care provider making a major error. This places the physician in an awkward and difficult position. Nonetheless, the observing physician has some obligation to see that the truth is revealed to the patient. This should be done in the least intrusive way. If the other health care provider does not reveal the error to the patient, the physician should encourage her to disclose her mistake to the patient. Should the health care provider refuse to disclose the error to the patient, the physician will need to decide whether the error was serious enough to justify taking the case to a supervisor or the medical staff office, or directly telling the patient. The observing physician also has an obligation to clarify the facts of the case and be absolutely certain that a serious mistake has been made before taking the case beyond the health care worker involved.

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  • Kapp MB. Medical mistakes and older patients: admitting errors and improving care. Journal of the American Geriatrics Society. 2001 Oct;49(10):1361-5. 
  • Rosner F, Berger JT, Kark P, Potash J, Bennett AJ. Disclosure and prevention of medical errors. Committee on Bioethical Issues of the Medical Society of the State of New York.  Archives of Internal Medicine.  2000 Jul 24;160(14):2089-92. 
  • Hall JK.  Legal consequences of the moral duty to report errors.  JONA'S Healthcare Law, Ethics and Regulation.   2003 Sep;5(3):60-4. 
  • Crook ED, Stellini M, Levine D, Wiese W, Douglas S. Medical errors and the trainee: ethical concerns.   The American Journal of the Medical Sciences.  2004 Jan;327(1):33-7. 
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An 18-month-old child presents to the clinic with a runny nose. Since she is otherwise well, the immunizations due at 18 months are administered. After she and her mother leave the clinic, you realize that the patient was in the clinic the week before and had also received immunizations then.

Should you tell the parents about your mistake?

Case Discussion

The error is a trivial one. Aside from the discomfort of the unnecessary immunization, no harm has resulted. Nonetheless, an open and honest approach to errors is most appropriate. While the parents may be angry initially about the unnecessary injection, they will appreciate your candor. On the other hand, should they discover the error and believe you have been dishonest, their loss of trust will be significant.

A 3-month-old has been admitted to the hospital with a newly diagnosed ventricular septal defect. She is in early congestive heart failure and digoxin is indicated. After discussing the proper dose with the attending physician, you write an order for the drug. Thirty minutes later the baby vomits and then has a cardiac arrest and dies. You discover that in writing the digoxin order you misplaced the decimal point and the child got 10 times too much digoxin.

What is your duty here? Will you get sued if you tell the truth?

Case Discussion

This unfortunate event represents a serious error with profound implications for the patient and family. You owe this family an honest explanation. They need to hear you say that you're sorry. Any attempt to hide the details of the event would be dishonest, disrespectful, and wrong. Though a lawsuit may follow, these parents are less likely to litigate if you deal with them honestly and take responsibility for the error.

A 3-year-old presents to the emergency department. She was diagnosed with pyelonephritis by her physician yesterday, treated with an intramuscular injection of antibiotic and sent home on an oral antibiotic. She is vomiting today and unable to keep the antibiotic down. As you prepare to admit her, you feel she should have been admitted yesterday.

Should you tell the parents that their physician made a mistake? How should you handle this disagreement?

Case Discussion

The practice of medicine is not an exact science. Frequently physicians will disagree about what constitutes the most appropriate management in a given case. Often these are legitimate disagreements with more than one acceptable course of action. Simply because you would have managed a patient differently does not mean the other physician made a mistake. In this case, you may wish to discuss the case with the other physician and explain why you manage children with pyelonephritis differently. However, in situations where standard practice varies, the parents should not be told that a mistake has been made.