The questionnaire was completed by 88 physicians working at KHCC; 55 (62.50%) received training at the workshop, and 33 (37.50%) did not. There were 57 (64.8%) males and 30 (34.1%) females with a male to female ratio of 1.9:1. There was no significant difference among the distribution of gender in both groups. The mean medical practice experience of all physicians was 16.5 years (range: 2 – 40 years). The mean experience for those who attended the workshop was 17.5 years, compared to 14.8 years of those who didn't (p-value = 0.169). Table 1 shows the participants’ characteristics.
|
|
Received Training
N= 55
|
Did not received training
N= 33
|
Gender
|
Male
|
34 (61.8%)
|
23 (69.7%)
|
Female
|
20 (36.4%)
|
10 (30.3%)
|
Experience (Years)
|
Min
|
3
|
2
|
Max
|
40
|
32
|
Mean
|
17.54
|
14.82
|
Table-1; Demographics of the study cohort.
No difference in medical error disclosure between participants in terms of gender and years of experience were found, whether they attended the workshop or not (Table-2).
Variable
|
|
|
Agree
|
Disagree
|
p-value
|
Gender
|
Male
|
Count (%)
|
39 (68.4%)
|
18 (31.6%)
|
0.786
|
Female
|
Count (%)
|
19(65.5%)
|
10(34.5%)
|
Experience
|
|
Count (median years of experience)
|
56 (15.84)
|
28 (17.82)
|
0.340
|
Table-2; Comparison of gender and years of experience in the total cohort.
We asked physicians about their likelihood of disclosure of errors that caused no harm, minor harm, and major harm. Eighty seven percent (n=73) of respondents (both groups) were more likely to report major harm, compared to minor harm or no harm (p-value 0.000). Table-3 displays the relation between the level of harm and the percentage of reporting physicians across all physicians, while table-4 shows compares the results between those who attended and those who did not.
Harm Caused
|
Received Training
|
Number (%) of respondents who were likely to disclosure
|
p-value
|
No Harm
|
Yes
|
26 (50.0)
|
0.179
|
No
|
23 (69.7)
|
Minor Harm
|
Yes
|
40 (76.9)
|
0.966
|
No
|
27 (81.8)
|
Major Harm
|
Yes
|
47 (92.2)
|
0.162
|
No
|
26 (78.8)
|
Table-3 Major harm was the level at which physicians would disclose to patients.
Harm Caused
|
Number (%) of respondents who were likely to disclose
|
P value
|
No Harm
|
49 (57.6%)
|
0.000
|
Minor Harm
|
67 (76.1%)
|
Major Harm
|
73 (86.9%)
|
Table-4 displays the relation between the level of harm and the percentage of physicians likely to disclose them.
Jordan’s Law on Medical and Healthcare Liability was addressed in two questions especially that this law came into effect recently. Physicians who attended the workshop were more knowledgeable of articles and elements than those who did not attend (p-value = 0.017). More so, the difference in knowledge on decision of error disclosure was in favor of physicians who have attended the workshop (p-value= 0.024). The majority of physicians in both groups preferred disclosure of medical errors because it is how they would want to be treated if they were patients (96.4% and 87.8%, respectively, p-value = 0.103). They also believed that disclosure of medical errors would help them alleviate the feeling of guilt (66.7% and 45.5%, respectively, p-value = 0.121. Almost half the physicians in both groups believed that disclosure of medical error would not strengthen the doctor-patient relationship (50.9% and 42.4%, respectively, p-value = 0.24). Interestingly though, physicians who received training were more inclined to disclose errors depending on their perception of whether this will help or harm the patients (72.7% and 57.6%, respectively, p-value =0.032) Table -5 summarizes the attitudes of physicians towards disclosing errors.
Questions
|
Received Training
|
Number (%) of
respondents who
agreed
|
p-value
|
I am aware and knowledgeable of the articles/elements of Jordan’s Medical and Health Liability Law
|
Yes
|
36 (66.7)
|
0.017
|
|
No
|
15 (45.5)
|
|
How likely would the issue of Jordan’s Law on Medical and Health Liability affect your decision to disclose an error to your patient?
|
Yes
|
34 (61.8)
|
0.024
|
|
No
|
12 (36.4)
|
|
It is important for me to tell my patients about errors I have made in their care because that is how I would want to be treated if I were a patient.
|
Yes
|
53 (96.4)
|
0.103
|
|
No
|
29 (87.8)
|
|
If I made a medical error, disclosing the error to my patient would help alleviate my feelings of guilt.
|
Yes
|
47 (87.0)
|
0.121
|
|
No
|
23(69.7)
|
|
Telling my patient about a medical error I have made in their care strengthens my patient’s trust in me as a physician.
|
Yes
|
28 (50.9)
|
0.24
|
|
No
|
14 (42.4)
|
|
My decision to disclose a medical error to a patient depends on whether I think the information will help or harm him/her.
|
Yes
|
40 (72.7)
|
0.032
|
|
No
|
19 (57.6)
|
|
Table 5. Attitudes toward error disclosure.
With respect to professional relationships between physicians and their peers, physicians in both groups felt the need to share the burden of a medical error (76.4% vs 62.5%, p-value = 0.24). Physicians in both groups recognized at least one colleague who would give them support if needed (94.5% vs 78.8%, p-value = 0.064). Reasons for wanting to share the incident with colleagues included learning whether they would have made the same clinical judgments and decisions (90.9% vs. 78.8%, respectively, p-value = 0.149), learning from their errors (85.5% vs. 75.8%, respectively, p-value =0.256), getting support and understanding (89.1% vs. 75.8%, respectively, p-value= 0.277), strengthening their professional relationships with the team (63.6% vs. 48.5%, respectively, p-value =0.350), and unburdening themselves (67.3% vs. 51.5%, respectively, p-value= 0.280). Interestingly, those who witnessed their mentors disclosing errors to patients were more likely to do the same in front of their students and residents than those who did not recall a similar experience with their mentors (71.0% vs. 29.0%, respectively, p-value =0.008) which reveals the importance of role modeling and the hidden curriculum.
When it comes to the relation with one’s institution, both groups believed that reporting medical errors to one’s own institution improves the quality of care for future patients (96.3% in the group who received the training and 84.8% who did not, p-value=0.15) and they believed that the benefits of reporting medical errors outweigh the negative consequences for those who report them (67.3% vs 66.7%, respectively, p-value = 0.290). However, 85.5% of physicians who received the training knew how to report medical errors to the institution, compared to 66.7% physicians who did not (p-value = 0.02). In addition, receiving a feedback from the institution would enhance reporting of medical errors as perceived by those who received training against who did not (85.2% vs 56.3%, p-value =0.003).
When thinking about disclosing medical errors, physicians who received the training and physicians who did not were both concerned about malpractice litigation (58.2% vs 59.4%, respectively, p-value = 0.042), blame from colleagues (60.0% vs 50.0%, respectively, p-value = 0.584), professional discipline (59.3% vs. 67.7%, respectively, p-value = 0.720), loss of reputation, (61.8% vs. 56.3%, respectively, p-value = 0.842), negative reaction from the patients or their families (58.2% vs 75.6%, respectively, p-value = 0.089), and negative publicity in the news media (58.2% vs 65.6%, respectively, p-value = 0.564).