Disclosing errors to patients can be difficult for clinicians. Fears of litigation and professional embarrassment can be barriers in these situations. But disclosing the medical errors in diagnosis or previous treatment committed by a referring physician or institution adds another layer of complexity.

To determine what those barriers might be and how they might be addressed to improve patient care, Lesly A. Dossett, MD, MPH, of the University of Michigan Institute for Health Policy and Innovation in Ann Arbor, and colleagues conducted semi-structured interviews of 30 cancer specialists from 2 cancer care centers who described having a greater than 50% reliance on external referrals. A thematic analysis of interview transcripts, published in the Annals of Surgery, was then performed to determine physician attitudes towards disclosing errors and barriers to providing full disclosure.

Pre-referral errors included errors of diagnosis, staging, and treatment resulting in adverse events that ranged from decreased quality of life to premature death. Most of the specialists appeared to feel that disclosure of errors that occurred prior to the referral would provide no benefit to patients and might increase their level of anxiety regarding their diagnoses or prognoses.

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Disclosure practices varied among specialists from no disclosure to non-verbal, partial, event-dependent, and full disclosure. Barriers included medicolegal concerns and damage to referral relationships, the reputation of a fellow physician, or to patient-physician relationships. Of note, the data also show that physicians may have divergent views regarding the role of disclosure for their own errors vs those committed by other physicians.

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Study limitations included the fact that a survey was not conducted that would have allowed for statistical analyses and the potential for generalizable results and that community-based cancer specialists may have different attitudes and practice patterns, particularly given their likely closer relationships with referring physicians.

The investigators concluded that education- or communication-based interventions to overcome barriers to disclosing pre-referral errors may need further development.


Dossett LA, Kauffmann RM, Lee JS, et al. Specialist physicians’ attitudes and practice patterns regarding disclosure of pre-referral medical errors [published online July 2017]. Ann Surg. doi:10.1097/SLA.0000000000002427