Doctors' views of attitudes towards peer medical error

Academic physician specialists' views toward the unproven stem cell intervention industry: areas of common ground and divergence

BACKGROUND AND AIMS

Premature commercialization of unproven stem cell interventions (SCIs) has received significant attention within the regenerative medicine community. Patients considering SCIs may encounter misinformation and seek out guidance from their physicians who are trusted brokers of health information. However, little is known about the perspectives of academic physician specialists toward the SCI industry. The purpose of this study was to capture the attitudes of physician specialists with experience addressing patient questions about unproven SCIs.

METHODS

The authors undertook 25 semi-structured interviews with academic physicians in cardiology, ophthalmology, orthopedics, pulmonology and neurology primarily from one academic center.

RESULTS

The authors identified two major themes: concerns and mediators of appropriateness of offering SCIs as therapies to patients. Specialists were generally aware of the industry and reported scientific and commercial concerns, including the scientific uncertainty of SCIs, medical harms to patients, misleading marketing and its impact on patient informed consent and economic harms due to large out-of-pocket costs for patients. All specialists outside of orthopedics voiced that it was inappropriate to be offering SCIs to patients today. These views were informed by previously expressed concerns surrounding safety and properly informing patients, levels of evidence needed prior to offering SCIs therapeutically and desired qualifications for clinicians. Among the specialties, orthopedists reported that under certain conditions, SCIs may be appropriate for patients with limited clinical options but only when safety is adequate, expectations are managed and patients are well informed about the risks and chances of benefit. Most participants expressed a desire for phase 3 studies and Food and Drug Administration approval prior to marketing SCIs, but some also shared the challenges associated with upholding these thresholds of evidence, especially when caring for out-of-option patients.

CONCLUSIONS

The authors' results suggest that medical specialists are aware of the industry and express several concerns surrounding SCIs but differ in their views on the appropriateness and clinical evidence necessary for offering SCIs currently to patients. Additional educational tools may help physicians with patient engagement and expectation management surrounding SCIs.

Disclosure of medical errors: physicians' knowledge, attitudes and practices (KAP) in an oncology center

Background

Between the need for transparency in healthcare, widely promoted by patient’s safety campaigns, and the fear of negative consequences and malpractice threats, physicians face challenging decisions on whether or not disclosing medical errors to patients and families is a valid option.

We aim to assess the knowledge, attitudes and practices (KAP) of physicians in our center regarding medical error disclosure.

Methods

This is a cross-sectional self-administered questionnaire study. The questionnaire was piloted and no major modifications were made.

A day-long training workshop consisting of didactic lectures, short and long case scenarios with role playing and feedback from the instructors, were conducted. Physicians who attended these training workshops were invited to complete the questionnaire at the end of the training, and physicians who did not attend any training were sent a copy of the questionnaire to their offices to complete. To assure anonymity and transparency of responses, we did not query names or departments.

Descriptive statistics were used to present demographics and KAP. The differences between response\s of physicians who received the training and those who did not were analyzed with t-test and descriptive statistics. The 0.05 level of significance was used as a cutoff measure for statistical significance.

Results

Eighty-eight physicians completed the questionnaire (55 attended training (62.50%), and 33 did not (37.50%)). Sixty Five percent of physicians were males and the mean number of years of experience was 16.5 years. Eighty-Seven percent (n = 73) of physicians were more likely to report major harm, compared to minor harm or no harm. Physicians who attended the workshop were more knowledgeable of articles of Jordan’s Law on Medical and Health Liability (66.7% vs 45.5%, p-value = 0.017) and the Law was more likely to affect their decision on error disclosure (61.8% vs 36.4%, p-value = 0.024).

Conclusion

Formal training workshops on disclosing medical errors have the power to positively influence physicians’ KAP toward disclosing medical errors to patients and possibly promoting a culture of transparency in the health care system.

Lessons for leadership and culture when doctors become second victims: a systematic literature review

This review set out to understand what leaders and organisational cultures can learn about supporting doctors who experience second victim phenomenon; the types, levels and availability of support offered; and the psychological symptoms experienced. A systematic review of keywords ‘Medical Error’ [MeSH], ‘Near Miss’, ‘Adverse Event’, ‘Second Victim’ and ‘Support’ was carried out using CINAHL Plus, Medline and Embase Classic and Embase 1947-2017 databases. Results show that poor organisational culture and leadership negatively influences and hinders doctors who make mistakes. Leaders who promote and create environments for open and constructive dialogue following adverse events enable the concept of fallibility and imperfection to be assimilated into new ways of learning. Guilt and fear are the most consistently reported psychological symptoms along with a perception of loss of professional respect and standing. Doctors often carry unresolved trauma for several years causing them to constantly relive an event. Unchecked, this can lead to poor relationships with colleagues and impact greatly on their ability to sleep and performance at work. The review concludes that a prevailing silence, exacerbated by poor organisational culture, inhibits proper disclosure to the first victim, the patient and family. It also impedes a healthy recovery trajectory for the doctor, the second victim. Leaders of organisations have a vital strategic and operational role in creating open, transparent and compassionate cultures where dialogue and understanding takes place for those affected by second victim phenomenon.

Exploring the utility of internal whistleblowing in healthcare via agent-based models

OBJECTIVE

The benefits of internal whistleblowing or speaking-up in the healthcare sector are significant. The a priori assumption that employee whistleblowing is always beneficial is, however, rarely examined. While recent research has begun to consider how the complex nature of healthcare institutions impact speaking-up rates, few have investigated the institutional processes and factors that facilitate or retard the benefits of speaking up. Here we consider how the efficacy of formal inquiries within organisations in response to employees' speaking up about their concerns affects the utility of internal whistleblowing.

DESIGN

Using computational models, we consider how best to improve patient care through internal whistleblowing when resource and practical limitations constrain healthcare operation. We analyse the ramifications of varying organisational responses to employee concerns, given organisational and practical limitations.

SETTING

Drawing on evidence from international research, we test the utility of whistleblowing policies in a variety of organisational settings. This includes institutions where whistleblowing inquiries are handled with varying rates of efficiency and accuracy.

RESULTS

We find organisational inefficiencies can negatively impact the benefits of speaking up about bad patient care. We find that, given resource limitations and review inefficiencies, it can actually improve patient care if whistleblowing rates are limited. However, we demonstrate that including softer mechanisms for internal adjustment of healthcare practice (eg, peer to peer conversation) alongside whistleblowing policy can overcome these organisational limitations.

CONCLUSION

Healthcare organisations internationally have a variable record of responding to employees who speak up about their workplace concerns. Where organisations get this wrong, the consequences can be serious for patient care and staff well-being. The results of this study, therefore, have implications for researchers, policy makers and healthcare organisations internationally. We conclude with a call for further research on a more holistic understanding of the interplay between organisational structure and the benefits of whistleblowing to patient care.