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Principal investigator:
Michelle Mello
Harvard University
Email: mmello@hsph.harvard.edu
Homepage: http://www.hsph.harvard.edu/michelle-mello/
Sample size: 2112
Field period: 5/10/2010-9/20/2010
Disclosing medical errors to patients and families is both a regulatory requirement and an ethical imperative. However, physicians' fear of malpractice liability is a major barrier to disclosure. Disclosure may increase medicolegal risk by alerting patients that they have been injured by medical management. To manage this risk, several healthcare institutions have implemented programs through which they make rapid offers of compensation (sometimes at modest levels) following disclosure of a medical injury, but little is known about these programs' effectiveness in deterring malpractice claims. Using a series of medical error vignettes, this study investigated the effects of early compensation offers on patients' propensity to sue following disclosure of a harmful error, compared to apology alone, including the importance of the amount of compensation offered.
We hypothesize that (1) compared to those who receive no compensation offer or an offer of limited compensation, those who receive an offer of full compensation will be less likely to seek legal advice in all scenarios; (2) for low-severity injuries, those receiving an offer of limited compensation will be more likely than those who receive no compensation offer to seek legal advice; and (3) compared to low-severity injuries, more serious injuries will be associated with a lower likelihood of accepting an offer, an increased propensity to seek legal advice, and a more negative emotional response.
We used a set of 16 medical error vignettes in which subjects randomly received 1 multi-paragraph vignette and were asked to imagine themselves as the injured patient. The vignettes represent a completely crossed factorial design, with 2 variants for type of error (surgical error vs. diagnostic error) and injury severity (serious vs. less serious) and 4 levels of the amount of compensation offered (none, waiver of medical costs only, offer to reimburse limited out-of-pocket expenses, or full restitution). In all vignettes, the physician was clearly responsible for the error and offered a full disclosure and apology.
Likelihood of accepting compensation offer, seeking legal advice, and changing physicians; perceptions of provider's motivations for admitting error and offering compensation; perceived entitlement to compensation.
Although patients welcome the inclusion of compensation offers in disclosure processes, more generous offers do not necessarily improve outcomes relative to more modest offers. Due to limits on prepublication dissemination, specific results will be available from the Principal Investigator following publication in a peer-reviewed medical journal.