Tuesday, April 4, 2017

Pathologists' Perspectives on Disclosing Harmful Pathology Error

Suzanne M. DintzisMD, PhDEmily K. ClennonBACarolyn D. ProutyDVMLisa M. ReichPhDJoann G. ElmoreMD, MPHThomas H. GallagherMD
From the Departments of Pathology (Dr Dintzis), Medicine (Ms Clennon and Drs Prouty, Reich, Elmore, and Gallagher), and Epidemiology (Dr Elmore), University of Washington, Seattle.
Reprints: Suzanne M. Dintzis, MD, PhD, Department of Pathology, University of Washington Medical Center, 325 Ninth Ave, Box 359791, Seattle, WA 98104 (email: ).
Context.— Medical errors are unfortunately common. The US Institute of Medicine proposed guidelines for mitigating and disclosing errors. Implementing these recommendations in pathology will require a better understanding of how errors occur in pathology, the relationship between pathologists and treating clinicians in reducing error, and pathologists' experiences with and attitudes toward disclosure of medical error.
Objective.— To understand pathologists' attitudes toward disclosing pathology error to treating clinicians and patients.
Design.— We conducted 5 structured focus groups in Washington State and Missouri with 45 pathologists in academic and community practice. Participants were questioned about pathology errors, how clinicians respond to pathology errors, and what roles pathologists should play in error disclosure to patients.
Results.— These pathologists believe that neither treating physicians nor patients understand the subtleties and limitations of pathologic diagnoses, which complicates discussions about pathology errors. Pathologists' lack of confidence in communication skills and fear of being misrepresented or misunderstood are major barriers to their participation in disclosure discussions. Pathologists see potential for their future involvement in disclosing error to patients, but at present advocate reliance on treating clinicians to disclose pathology errors to patients. Most group members believed that going forward pathologists should offer to participate more actively in error disclosure to patients.
Conclusions.— Pathologists lack confidence in error disclosure communication skills with both treating physicians and patients. Improved communication between pathologists and treating physicians could enhance transparency and promote disclosure of pathology errors. Consensus guidelines for best practices in pathology error disclosure may be useful.

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