One of the principles behind of my family’s legislative bill is that a patient has the right to know about any harmful error that has occurred during his or her care. I am looking for arguments against this, and I found one at Law & Medicine, by Victor Cotton, MD, JD. The argument goes like this: Just because people want to know something, that doesn’t mean they have the right to know. And besides, many patients don’t want to know about errors. It is the trial lawyers who want to know about errors, and they are trying to pass this off as a patient right.
The claim that many patients do not want to know about errors immediately jumped out at me. I vaguely remember reading one study that found a very small percent (something like 2%) of patients didn’t want to know about errors. So I was very curious about where Dr. Cotton got his statistic.
(As a side note, I have the solution to the problem of accommodating patients who do not want to know about errors. A disclosure conversation should begin by the healthcare professional saying that an error has occurred, asking if the patient/family would like to know more, and then waiting for a response. If people don’t want to know about an error, they can simply say “no”. Problem solved.)
Anyway, the page from Dr. Cotton’s website says, “Hobgood found that 24% of patients do not want to know about a medical error and 33% do not want to know the full extent of an error.”
I downloaded the paper and skimmed through it. I quickly realized the paper does not say what Dr. Cotton claims. Instead the authors wrote this in their Results section:
This study investigated when patients wanted to be told about errors (immediately or after more is known) and the types of errors they wanted to be told about (all errors or only ones that are harmful or could be harmful). The survey did not have a question that directly asked if patients wanted to be told about errors—which would be a simple “yes” or “no”. (I do think that is odd. If this was my survey I would have added that question.) So Dr. Cotton’s assertion that this study is evidence that many patients do not want to know about medical errors is completely baseless.
(Here are a few more details about the survey: Patients and family members waiting in an ER were given a multiple-choice survey that asked 1) what types of mistakes would you want to know about, 2) when you would want to know about the mistake, 3) whether the mistake should be reported to a government agency, 4) whether the mistake should be reported to the state medical board, 5) whether the mistake should be reported to the hospital committee focusing on mistakes, and 6) how people who teach physicians should deal with mistakes. The survey was done in the summer of 2000 and 258 completed surveys were received.)
Dr. Cotton has copied the abstract of this paper to his web page. Except a single word is missing. The rest of the abstract is identical. Here are the abstracts. The original is on top, Dr. Cotton’s copy is below:
It is difficult to imagine how one particular word was (uhmmm…accidently?) removed. But regardless of how that happened, it is clear that Dr. Cotton has not read the paper he is basing his argument on. I suspect that he held a particular belief concerning medical error disclosure, and was simply looking for evidence to confirm his belief.
Citing a study as evidence for an argument without reading the study is a serious ethical breach. Especially when someone is in the business of providing continuing medical education (CME) to physicians. (Yes, Dr. Cotton’s online business, Law and Medicine Media, is accredited to sell CME, as you can see here.)
And this misinformation by Dr. Cotton is not confined to his website. He also wrote a piece for Physician Insurer Magazine last year in which he again claims that the study concluded that 24% of patients did not want to know about errors (archived here). Here is a screenshot of the statement:
I have no tolerance for this deception. I realize it is much easier to make up “facts” and twist information to suit your own biases then it is to do the hard work of understanding complex problems. But I am here to solve problems, not sell propaganda.
When I find deception, I will call it out. And I don’t care what “side” you are on.
I am now going to write a friendly letter to Dr. Cotton and inform him of this error. I will let you know if I get a response.
I have no doubt that Dr. Cotton will thank me for catching this. As he has stated, his “Law and Medicine Research Institute is dedicated to the scientific study of the intersection of law and medicine. The Institute primarily addresses areas where scientific truth has been compromised by the influence of trial lawyers and other non-clinicians whose interests are not the advancement of patient care.”