A nationwide survey of nearly 700 patients who either experienced harm themselves or whose relatives were harmed by medical errors reveals that trust makes a difference in whether those patients and families take legal action.
Of the 1,805 mishaps detailed in the survey, the most frequent were diagnostic errors, surgical or procedural complications, hospital-associated infections and medication errors. Patients in the survey were treated for conditions or with procedures that included brain tumors, upper gastrointestinal-tract endoscopies, sinus surgery, pulmonary emboli, diabetes and severe cough.
Their adverse events led to financial losses, the need for additional treatment, permanent disability and death, among other outcomes.
In many cases, the survey respondents perceived a lack of accountability, disrespect or poor communication from their providers, according to findings published in the June issue of BMJ Quality & Safety.
And when patients or their relatives perceived the health system as untrustworthy or designed to hide fault, they were more likely to take legal action.
Among those who pursued a legal solution, 27% reached the settlement phase and 17% received compensation. Six reported settlements of $500,000 or more, the authors told Modern Healthcare.
"Litigation is an inadequate solution to the problem," said Dr. Frederick Southwick, an infectious disease professor at the University of Florida College of Medicine and one of the co-authors of the BMJ study. “Injured patients and their families should be allies, not adversaries.”
"Patients are not asking for something that is unrealistic,” added study co-author Julia Hallisy, president of the Empowered Patient Coalition. They want honesty and perhaps an apology, she said. "But the system is not designed to support either."
Anxiety over potential lawsuits and the fear of retaliation from their employer are often cited as impediments that prevent clinical staff from owning up to a mistake. But establishing a venue where clinicians can discuss mishaps and possibly prevent future harmful incidents from occurring is critical to creating the "culture of safety" that is often talked about, yet difficult to achieve in healthcare.
Systemic flaws that could or do lead to patient harm remain prevalent. That's why a recent National Patient Safety Foundation report encouraged providers and health systems to start focusing more heavily on "near misses" rather than simply analyzing errors after they occur.
“When a patient is injured, providers feel guilty,” Southwick said.
But, as Southwick and many others have noted, "Errors are often complex and a high percentage are caused by system defects rather than the individual."
For the BMJ study, researchers posted a voluntary survey on the Empowered Patient Coalition website. It included both quantitative questions, as well as the opportunity to provide open-ended narratives about care experiences. Participants were recruited using an e-mail list from the Safe Patient Project of the Consumers Union. Researchers gathered 696 responses.
“A great number of patients were not interested in anonymity as we assumed they might be,” said Hallisy. “They wanted to tell their complete story.”
According to an analysis of the narratives, many individuals felt "a desperate need for answers that never came.”
