Ethics

Promoting Patient Safety

Code of Medical Ethics Opinion 8.6

In the context of health care, an error is an unintended act or omission or a flawed system or plan that harms or has the potential to harm a patient. Patients have a right to know their past and present medical status, including conditions that may have resulted from medical error. Open communication is fundamental to the trust that underlies the patient-physician relationship, and physicians have an obligation to deal honestly with patients at all times, in addition to their obligation to promote patient welfare and safety. Concern regarding legal liability should not affect the physician’s honesty with the patient.

Even when new information regarding the medical error will not alter the patient’s medical treatment or therapeutic options, individual physicians who have been involved in a (possible) medical error should:

(a) Disclose the occurrence of the error, explain the nature of the (potential) harm, and provide the information needed to enable the patient to make informed decisions about future medical care.

(b) Acknowledge the error and express professional and compassionate concern toward patients who have been harmed in the context of health care.

(c) Explain efforts that are being taken to prevent similar occurrences in the future.

(d) Provide for continuity of care to patients who have been harmed during the course of care, including facilitating transfer of care when a patient has lost trust in the physician.

Physicians who have discerned that another health care professional (may have) erred in caring for a patient should:

(e) Encourage the individual to disclose.

(f) Report impaired or incompetent colleagues in keeping with ethics guidance.

As professionals uniquely positioned to have a comprehensive view of the care patients receive, physicians must strive to ensure patient safety and should play a central role in identifying, reducing, and preventing medical errors. Both as individuals and collectively as a profession, physicians should:

(g) Support a positive culture of patient safety, including compassion for peers who have been involved in a medical error.

(h) Enhance patient safety by studying the circumstances surrounding medical error. A legally protected review process is essential for reducing health care errors and preventing patient harm.

(i) Establish and participate fully in effective, confidential, protected mechanisms for reporting medical errors.

(j) Participate in developing means for objective review and analysis of medical errors.

(k) Ensure that investigation of root causes and analysis of error leads to measures to prevent future occurrences and that these measures are conveyed to relevant stakeholders.

AMA Principles of Medical Ethics: I, II, III, IV, VIII

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