Not all doctors fully disclose errors, pharma ties, bad prognoses, survey finds

A significant proportion of physicians do not completely agree that they should disclose serious medical errors or financial relationships with drug and device companies to patients, according to a recent survey. In addition, one-tenth of survey respondents had told patients something that was not true in the previous year.

Researchers surveyed 1,891 physicians in internal medicine, family practice, pediatrics, cardiology, general surgery, anesthesiology and psychiatry nationwide in 2009 to find out if they followed the standards on communication laid out by the American Board of Internal Medicine Foundation's Charter on Medical Professionalism. That charter was coauthored by the American College of Physicians and later endorsed by more than 100 groups worldwide, as well as the Accreditation Council for Graduate Medical Education. The survey excluded osteopaths, residents and those who practiced in federally owned hospitals.

Results appeared in the February 2012 Health Affairs.

Nearly 20% of physicians said they had not fully disclosed an error to a patient in the previous year because they feared the admission would trigger a malpractice case. More than 55% of physicians said they often or sometimes described a patient's prognosis in a more positive manner than warranted and 35% did not completely agree that they should disclose all financial ties with drug- and devicemakers to patients.

Women physicians were more likely to report fully describing benefits and risks, disclosing financial relationships, and never having told an untruth in the prior year. Race or ethnicity was significantly associated with never telling a lie and never disclosing confidential information: Underrepresented minorities were more likely than white or Asian respondents to report attitudes consistent with the charter. International medical graduates were less likely than U.S. grads to have told a patient something untrue or to have disclosed confidential patient information in the past year.

General surgeons and pediatricians were most likely to completely support disclosing all serious medical errors to patients, while cardiologists and psychiatrists were least likely (P<0.001). Anesthesiologists, general surgeons and pediatricians were most likely to report never having described patients' prognoses in more positive terms than warranted, while internists and psychiatrists were least likely (P<0.05). Cardiologists and general surgeons were most likely to report never having told patients an untruth in the previous year, while pediatricians and psychiatrists were least likely (P<0.001). Physicians in universities or medical centers were more likely to completely agree with the need to report all serious medical errors than physicians in solo or two-person practices (78.1% vs. 60.5%; P=0.03).

Even though the survey was anonymous, it likely underestimated the rate at which physicians do not comply with the professionalism charter, the study authors speculated. “The survey results suggest that many physicians do not completely support the charter requirements related to communication with patients. An alternative interpretation is that treating support for the charter precepts as ‘black or white’—physicians either do or do not completely endorse and adhere to these principles—fails to recognize complexities of patient physician communication in everyday practice,” they wrote.

“Despite the relative clarity and unambiguous language of the charter precepts, many factors can affect how and what physicians communicate to patients,” the authors continued. “Some might argue that knowing when to breach or bend these rules when individual patients require a different approach constitutes clinical wisdom and true patient-centeredness.”