The medical community has embraced the concept of disclosing medical errors to patients promptly and honestly, but there is still some question about how to handle pediatric patients. Should you tell a child that you made a mistake? If so, how?
In a recent study involving Chicago pediatricians, nearly all of them supported disclosing errors to parents, but only about half supported disclosure to children. Among those who supported disclosure to children, most agreed that 12 years old was the age at which the patient is developmentally ready to be told about medical errors. (An abstract of the report,published in Academic Pediatrics, is available online at http://1.usa.gov/1SwgYjr.)
The study was an attempt to fill a gap in research regarding medical disclosure, says Irini Kolaitis, MD, an instructor in pediatric hospital-based medicine at the Ann & Robert H. Lurie Children’s Hospital of Chicago. Previous research has confirmed that pediatricians support disclosure as much other medical professionals, but it has not been clear if they fully supported disclosure to children or just to parents.
“We support disclosure fully, and we have risk management and hospital administration involved,” Kolaitis says. “But there is no policy at our hospital in terms of policies or general statements on when and if to talk to a pediatric patient about an error. I think that’s typical of hospitals nationwide.”
Kolaitis surveyed 1,200 members of the American Academy of Pediatrics and asked the doctors about one of four possible cases that only varied by patient age (16 or 9 years old) and by whether the medical error resulted in reversible or irreversible harm. The hypothetical medical error was a medication error that led to kidney damage in a chemotherapy patient, with one permanently injured and on dialysis and the other recovering.
Kolaitis and her colleagues found that 98% of respondents believed it was “very important” to disclose medical errors to parents, while only 57% had the same approach to pediatric patients. Assuming the pediatric patients were developmentally normal, the respondents indicated that medical errors could be disclosed to them at a mean age of 12.15 years old and older. They were largely in agreement that medical errors should not be discussed with patients below a mean age of 10.25 years old.
Most of those surveyed, 72%, said physicians and parents should jointly decide whether to disclose an error to pediatric patients. When disclosing an error to a young patient, 88% of respondents said the parents should be present.
“They thought it was particularly important to disclose to an older patient when it was an irreversible error, like a kid ending up on dialysis,” Kolaitis explains. “If the parents asked them not to disclose, most of them would acquiesce to the parents’ request, but they wouldn’t lie if the patient asked them directly.”
Kolaitis notes that pediatric patients know more about their illnesses than parents and health professionals think they do.
“This should be a partnership with the parents and the hospital administration as well,” Kolaitis says. “The physicians clearly felt there was an age where most pediatric patients would be able to receive that information well, but it seemed there might not be a concrete rule in pediatrics. With adult patients, the consensus is clear that you disclose errors, but with pediatrics, you might have to assess each case on its merits and determine what’s right.”
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Irini Kolaitis, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago. Email: [email protected].
