In 1999, when Linda Kenney was about to undergo ankle-replacement surgery at Brigham and Women’s Hospital in Boston, anesthesiologist Rick A. van Pelt inserted a needle behind her knee to administer a nerve block and, seeing no blood, assumed the needle was in the right place. But in less than a minute, Kenney had a seizure, then went into full cardiac arrest. A heart team took over, and her chest was cracked open. The surgery succeeded, and although Kenney was in bad shape—chest wired shut, ribs broken, short-term memory loss—she was told she was lucky to be alive.

Shortly after she was discharged, though, Kenney received a letter of apology from van Pelt. And in a phone conversation with her six months later, he explained that her cardiac arrest had apparently resulted from the drug he administered, possibly because the needle had hit a broken blood vessel. Van Pelt told her that the hospital had prevented him from talking to her while she was an inpatient because of the litigation risk, and he “was expected to function as if nothing had happened,” coping with “the guilt, vulnerability and shame on my own.”

Kenney declined to sue, and doctor and patient decided to take their story public, repeating it during appearances in the United States and abroad to promote the idea that both patients and providers have emotional needs after a mishap. At Brigham and Women’s, staff members can request peer-to-peer support sessions—modeled after those used by Boston’s firefighters, police and emergency medical services teams—to help them deal with their own reactions. “If you support your providers this way, it’s logical for them to want to talk to the patient and family about what happened,” says van Pelt.

Yet such openness remains rare, in part because of litigation risks when mistakes are acknowledged. Although many states have laws preventing physicians’ apologies from being used against them in court, plaintiffs’ attorneys often view such admissions as a smoking gun. And despite success at a few institutions that have owned up to medical mistakes, checkbook in hand, most hospitals and doctors resist the notion.

In a recent survey of surgeons and primary care physicians, Thomas H. Gallagher, associate professor of medicine at the University of Washington in Seattle, found that while 80% said they would tell a patient about an obvious error—a sponge left behind during surgery, say—only half would disclose a mistake that the patient wouldn’t detect, such as an episode of tachycardia caused by overlooking lab test results showing elevated potassium levels. Just one-third would apologize for any error.

“Patients really care about having an error explicitly acknowledged, but physicians struggle with how much information to provide,” says Gallagher, who believes there’s a need for standards that clearly outline what doctors must tell patients and what situations might justify disclosing less. “Physicians should feel comfortable that disclosure is the right thing to do and that it is likely to have a positive effect on malpractice litigation,” he adds. Within a decade, “full and frank disclosure to patients is likely to be the norm rather the exception,” he predicts—and a major step in “restoring the public’s trust in the honesty and integrity of the health care system.”

Dossier

1. “Medical Liability: Beyond Caps,” Health Affairs, July/August 2004. Excellent overview of the current medical malpractice crisis, including articles that explore ideas for an improved litigation process and offer a look at California’s long-standing tort reform.

2. “Disclosing Medical Errors to Patients: Attitudes and Practices of Physicians and Trainees,” by Lauris C. Kaldjian et al., Journal of General Internal Medicine, July 2007. A look at how often physicians say they admit to medical errors—and how infrequently they really do.

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