The American Medical Association’s Code of Medical Ethics establishes clear duties for physicians following an actual or possible medical error. These responsibilities appear in Opinion 8.6, “Promoting Patient Safety.”
The AMA states that patients have a right to know about their medical condition, including conditions that may have resulted from an error. It emphasizes that open communication is fundamental to trust between physicians and patients.
The Code also states:
“Concern regarding legal liability should not affect the physician’s honesty with the patient.”
Under Opinion 8.6, physicians involved in an actual or possible medical error should:
The opinion also directs physicians to participate in confidential error-reporting and review systems, study the circumstances surrounding errors, and ensure that root-cause investigations lead to measures that prevent similar harm.
These are ethical responsibilities established by the AMA Code. In some cases, physicians and hospitals may also have legal disclosure obligations under applicable state or federal law.
Source: AMA Code of Medical Ethics Opinion 8.6—Promoting Patient Safety
In 2015, ProPublica published “The Voices of Patient Harm,” presenting the experiences of 1,010 patients and family members from all 50 states. Respondents described what happened when they or a loved one experienced harm during medical care—and how medical providers and facilities responded afterward.
The reported harm included:
Much of the harm described was severe. Death and permanent disability were among the most frequently reported outcomes.
Most of the incidents reportedly occurred in hospitals.
Only about 1 in 10 respondents said the hospital or other medical facility voluntarily acknowledged the harm.
Approximately another 1 in 10 said the facility acknowledged the harm only after pressure, such as a complaint or lawsuit.
Nearly all the remaining respondents said the facility either denied that harm occurred or failed to acknowledge it.
Only 13% said an individual doctor, nurse, or other caregiver voluntarily disclosed the harm.
Patients and families frequently described encountering:
Many said they did not receive a direct explanation of what happened or why it happened.
Only 13% reported receiving an apology.
This means that nearly seven out of eight respondents said neither the patient nor the family received one.
Only about 1 in 20 respondents believed that the medical facility or individual provider experienced consequences for the harm.
ProPublica did not independently determine whether disciplinary proceedings, retraining, corrective actions, or other measures took place. Its finding reflects what patients and families reported knowing or observing.
A central theme in the responses was that many patients and families felt harmed twice: first by the medical event and then by the healthcare system’s response.
Some said they were treated as adversaries when they asked questions. Others described being unable to obtain a clear explanation of what happened, whether the harm could have been prevented, or what would be done to prevent it from happening again.
ProPublica concluded that the accounts revealed a widespread lack of transparency following medical harm. Patients and families frequently reported that the harm was not voluntarily acknowledged, clearly explained, apologized for, or followed by visible corrective action.
Before ProPublica published the results from 1,010 respondents, researchers at the Johns Hopkins University School of Medicine independently analyzed an earlier group of 236 responses to ProPublica’s questionnaire.
The participants completed the questionnaire during a one-year period ending in May 2013 and consented to having their information used for research. The study was led by Dr. Marty Makary, a professor of surgery, and published in the Journal of Patient Safety in 2014.
The Johns Hopkins analysis found:
These earlier findings were similar to patterns later reported among the larger group of ProPublica questionnaire respondents. However, the Johns Hopkins analysis should not be considered independent confirmation of ProPublica’s later results because both groups came from the same continuing questionnaire project.
Source: ProPublica—“The Two Things That Rarely Happen After a Medical Mistake”
ProPublica’s questionnaire was not a scientific survey. Participants volunteered to respond and were not randomly selected. Their accounts were self-reported, and ProPublica did not independently verify the incidents.
The percentages therefore describe the people who completed the questionnaire. They should not be viewed as the percentage of all American patients who experience denial, nondisclosure, or a lack of apology following medical harm.
Nor did the questionnaire verify that every reported injury was caused by a confirmed medical error.
Nevertheless, the responses suggest a significant gap between the AMA’s ethical guidance and what many harmed patients and families said they experienced: silence, denial, few apologies, and little visible accountability.
