Surgeons still try to cover up errors

DOCTORS ARE still reluctant to tell patients when they make an error, despite warnings that they could be struck off if they try to bury their mistakes.

Four out of ten specialists surveyed for a study, published in the British Medical Journal, said they did not believe patients should always be told when a complication occurred and two-thirds did not agree that the patients should be given detailed information about the possible consequences. In contrast, more than nine out of ten patients said they should be told about a mistake and more than eight out of ten said they would want to know what might happen as a result.

The findings come after a series of cases that have highlighted the institutional secrecy of medicine and the tendency of doctors to close ranks and cover for errant colleagues. Hearings begin later this month in the Bristol baby deaths inquiry, which will examine how warnings about the high death rate at Bristol Royal Infirmary during the late 1980s and early 1990s went unheeded for years.

The General Medical Council, the doctors' disciplinary body, revised its guidance on good medical practice in 1997. It now says that after an adverse event a full and honest explanation and an apology should be provided routinely.

In the study, Dr Leslie Hingorani and colleagues at the Central Middlesex Hospital, London, asked a group of patients attending an ophthalmology clinic to imagine an incident in which a surgeon carrying out a cataract operation makes a small error, as a result of which the lens capsule breaks.

The surgeon has to insert stitches and a larger lens than he planned and there is a one in ten chance that the patient's vision will be affected. However, next day the patient, a woman, sees well and is pleased. Should she be told?

Of 248 patients questioned, 92 per cent said they would want to be told and 81 per cent said they would want details of what could happen. Among 48 consultant ophthalmologists 60 per cent said the patient should be told and 33 per cent believed she should be given details.

The authors say that doctors may be reluctant to tell out of a desire to protect patients from anxiety. But they may also fear losing the patient's trust, being blamed and perhaps sued. Yet many studies show that failing to provide information increases the risk of litigation and the longer an explanation is left the more difficult it is to provide. They add: "The practice of medicine can never be free of errors and changes are required in the attitudes of both patients and the medical profession."

The General Medical Council said doctors who fail to acknowledge mistakes could face misconduct charges.

t The British Medical Association warned that 350 obstetricians were facing redundancy because there are too few consultant posts for the number being trained. It called on the Government to establish new consultant posts "to provide recommended standards of care in labour".