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Biomedical subjects

Thomas H Gallagher

Publications and source records attributed to Thomas H Gallagher.

13 recordsLinked to original sources
PubMed2006

Brief report: Hospitalized patients' attitudes about and participation in error prevention.

BACKGROUND AND OBJECTIVE: Although many patient safety organizations and hospital leaders wish to involve patients in error prevention, it is unknown whether patients will take the recommended actions or whether error prevention involvement affects hospitalization satisfaction. DESIGN AND PARTICIPANTS: Telephone interviews with 2,078 patients discharged from 11 Midwest hospitals. RESULTS: Ninety-one percent agreed that patients could help prevent errors. Patients were very comfortable asking a medication's purpose (91%), general medical questions (89%), and confirming their identity (84%), but were uncomfortable asking medical providers whether they had washed their hands (46% very comfortable). While hospitalized, many asked questions about their care (85%) and a medication's purpose (75%), but fewer confirmed they were the correct patient (38%), helped mark their incision site (17%), or asked about handwashing (5%). Multivariate logistic regression revealed that patients who felt very comfortable with error prevention were significantly more likely to take 6 of the 7 error-prevention actions compared with uncomfortable patients. CONCLUSIONS: While patients were generally comfortable with error prevention, their participation varied by specific action. Since patients who were very comfortable were most likely to take action, educational interventions to increase comfort with error prevention may be necessary to help patients become more engaged.

Adult↗
PubMed2005

How surgeons disclose medical errors to patients: a study using standardized patients.

BACKGROUND: Calls are increasing for physicians to disclose harmful medical errors to patients, but little is known about how physicians perform this challenging task. For surgeons, communication about errors is particularly important since surgical errors can have devastating consequences. Our objective was to explore how surgeons disclose medical errors using standardized patients. METHODS: Thirty academic surgeons participated in the study. Each surgeon discussed 2 of 3 error scenarios (wrong-side lumpectomy, retained surgical sponge, and hyperkalemia-induced arrhythmia) with standardized patients, yielding a total of 60 encounters. Each encounter was scored by using a scale developed to rate 5 communication elements of effective error disclosure. Half of the encounters took place face-to-face; the remainder occurred by videoconference. RESULTS: Surgeons were rated highest on their ability to explain the medical facts about the error (mean scores for the 3 scenarios ranged from 3.93 to 4.20; maximum possible score, 5). Surgeons used the word error or mistake in only 57% of disclosure conversations, took responsibility for the error in 65% of encounters, and offered a verbal apology in 47%. Surgeons acknowledged or validated patients' emotions in 55% of scenarios. Eight percent discussed how similar errors would be prevented, and 20% offered a second opinion or transfer of care to another surgeon. CONCLUSIONS: The patient safety movement calls for disclosure of medical errors, but significant gaps exist between how surgeons disclose errors and patient preferences. Programs should be developed to teach surgeons how to communicate more effectively with patients about errors.

Communication↗
PubMed2005

Patient concerns about medical errors in emergency departments.

OBJECTIVE: Despite large numbers of emergency encounters, little is known about how emergency department (ED) patients conceptualize their risk of medical errors. This study examines how safe ED patients feel from medical errors, which errors are of greatest concern, how concerns differ by patient and hospital characteristics, and the relationship between concerns and willingness to return for future care. METHODS: Multiwave telephone interviews of 767 patients from 12 EDs were conducted. Patients were asked about their medical safety, concern about eight types of medical errors, and satisfaction with care. RESULTS: Eighty-eight percent of patients believed that their safety from medical errors had been good, very good, or excellent; 38% of patients reported experiencing at least one specific error-related concern, most commonly misdiagnosis (22% of all patients), physician errors (16%), medication errors (16%), nursing errors (12%), and wrong test/procedure (10%). Concerns were associated with gender (p < 0.01), age (p < 0.0001), ethnicity (p < 0.001), length of stay (p < 0.001), ED volume (p < 0.0001), day of week (p < 0.0001), and hospital type (p < 0.0001). Concerns were highly related to a patient's willingness to return to the ED. CONCLUSIONS: The majority of ED patients felt relatively safe from medical errors, yet a significant percentage of patients experienced concern about a specific error during their emergency encounter. Concerns varied by both patient and hospital characteristics and were highly linked to patient satisfaction. The selective nature of concerns may suggest that patients are attuned to cues they perceive to be linked to specific medical errors, but efforts to involve patients in error detection/prevention programs will be challenging given the stressful and intimidating nature of ED encounters.

Adolescent↗
PubMed2005

Development and implementation of a Clerkship Counseling Hotline.

BACKGROUND: The 3rd year of medical school is stressful, yet students may hesitate to access their school's mental health services. DESCRIPTION: We instituted the Clerkship Counseling Hotline, an anonymous, 24-hour cell phone hotline staffed by an independent counselor. EVALUATION: Hotline calls were logged, and students were surveyed regarding the hotline. Seventeen students called the hotline 25 times during the year. Callers' concerns included disillusionment with medicine, anxiety over performance, and personal problems. The hotline did not reduce overall student stress compared with the 3rd-year classes preceding the hotline. However, 75% said continuing the hotline was important, and 75% found the hotline's availability reassuring. CONCLUSION: A clerkship counseling hotline may enhance medical schools' mental health resources.

Clinical Clerkship↗
PubMed2004

Using focus groups to understand physicians' and nurses' perspectives on error reporting in hospitals.

BACKGROUND: To increase error reporting, a better understanding of physicians' and nurses' perspectives regarding medical error reporting in hospitals, barriers to reporting, and possible ways to increase reporting is necessary. METHODS: Nine focus groups--four with 49 staff nurses, two with 10 nurse managers, and three with 30 physicians--from 20 academic and community hospitals were conducted in May-June 2002 in the St. Louis metropolitan area. Qualitative analysis of focus group transcripts characterized participants' perspectives. RESULTS: Although participants knew they should report errors associated with serious adverse events, there was much uncertainty about reporting less serious errors or near misses. Nurses were more knowledgeable than physicians about how to report errors. All groups mentioned barriers to reporting, such as fear of reprisals and lack of confidentiality, time, and feedback after an error is reported. Some physicians doubted the benefit of reporting errors, but, generally, both physicians and nurses agreed that reporting was intended to change practice and policy to promote patient safety. CONCLUSIONS: A culture characterized by anonymous reporting, freedom from repercussions, and feedback about error reports should promote error reporting.

Academic Medical Centers↗
PubMed2004

A prescription for protecting the doctor-patient relationship.

The relationship between patients and their physicians is fundamental to high-quality care, yet this relationship is under stress in the current healthcare environment. Health plans have instituted a variety of policies to contain costs, not fully appreciating the adverse effect these decisions have on the doctor-patient interaction. Legislators have responded to the public's concern about managed care with "patient protection" bills that fail to address the fundamental causes of tension between doctors and patients. This paper presents a model describing how the need to contain costs affects the doctor-patient interaction and proposes a prescription for protecting the relationship. The model highlights how the healthcare environment affects patients' and physicians' expectations before a medical visit, the nature of their interaction during a visit, and patients' health outcomes. This prescription for protecting the doctor-patient relationship contains 4 key ingredients: (1) definition and promulgation of evidence-based standards for the doctor-patient relationship; (2) joint doctor-patient advocacy on behalf of the relationship; (3) positive incentives for exemplary doctor-patient relationships; and (4) expanded training and assessment of physicians' communication skills, both in general and related to discussing cost containment with patients. These measures will help restore the essential element of superb healthcare: a strong doctor-patient relationship.

Attitude↗
PubMed2003

Patients' and physicians' attitudes regarding the disclosure of medical errors.

CONTEXT: Despite the best efforts of health care practitioners, medical errors are inevitable. Disclosure of errors to patients is desired by patients and recommended by ethicists and professional organizations, but little is known about how patients and physicians think medical errors should be discussed. OBJECTIVE: To determine patients' and physicians' attitudes about error disclosure. DESIGN, SETTING, AND PARTICIPANTS: Thirteen focus groups were organized, including 6 groups of adult patients, 4 groups of academic and community physicians, and 3 groups of both physicians and patients. A total of 52 patients and 46 physicians participated. MAIN OUTCOME MEASURES: Qualitative analysis of focus group transcripts to determine the attitudes of patients and physicians about medical error disclosure; whether physicians disclose the information patients desire; and patients' and physicians' emotional needs when an error occurs and whether these needs are met. RESULTS: Both patients and physicians had unmet needs following errors. Patients wanted disclosure of all harmful errors and sought information about what happened, why the error happened, how the error's consequences will be mitigated, and how recurrences will be prevented. Physicians agreed that harmful errors should be disclosed but "choose their words carefully" when telling patients about errors. Although physicians disclosed the adverse event, they often avoided stating that an error occurred, why the error happened, or how recurrences would be prevented. Patients also desired emotional support from physicians following errors, including an apology. However, physicians worried that an apology might create legal liability. Physicians were also upset when errors happen but were unsure where to seek emotional support. CONCLUSIONS: Physicians may not be providing the information or emotional support that patients seek following harmful medical errors. Physicians should strive to meet patients' desires for an apology and for information on the nature, cause, and prevention of errors. Institutions should also address the emotional needs of practitioners who are involved in medical errors.

Adult↗
PubMed2003

Patient-provider discussions about conflicts of interest in managed care: physicians' perceptions.

BACKGROUND: Patients worry about financial conflicts of interest related to cost containment but may hesitate to share this concern with their physician. Little is known about how this issue affects encounters between doctors and patients, or about the communication strategies physicians endorse for responding to such concerns. OBJECTIVE: To understand physicians' perspectives on how managed care patients' concerns about conflicts of interest are impacting the physician-patient relationship in routine visits. STUDY DESIGN: Qualitative analysis of physician focus groups. Physicians also rated audiotaped dialogues of different communication strategies for discussing conflicts of interest with patients. PARTICIPANTS: Thirty-nine community physicians (25 general internists and 14 family practice physicians) in Portland, Oregon--a highly penetrated managed care market. Physicians' average age was 44 years; 36% were women. RESULTS: These physicians report that patient concern about financial conflicts of interest is implicit in many patient encounters. However, patients rarely ask directly about conflicts of interest. Physicians believe that patients' concerns about conflicts of interest are impairing doctor-patient relationships and damaging physicians' sense of professional worth. Physicians prefer communication strategies for discussing conflicts of interest that address patients' emotions or identify a common goal through negotiation. These physicians seldom initiate discussions with patients about conflicts of interest. CONCLUSIONS: Patient concern about conflicts of interest is adversely impacting the physician-patient interaction. Physicians should be alert to patients' implicit expressions of concern about conflicts of interest, and practice communication techniques for responding to these concerns effectively.

Adult↗
PubMedDate not supplied

Choosing your words carefully: how physicians would disclose harmful medical errors to patients.

BACKGROUND: A gap exists between patients' desire to be told about medical errors and present practice. Little is known about how physicians approach disclosure. The objective of the present study was to describe how physicians disclose errors to patients. METHODS: Mailed survey of 2637 medical and surgical physicians in the United States (Missouri and Washington) and Canada (national sample). Participants received 1 of 4 scenarios depicting serious errors that varied by specialty (medical and surgical scenarios) and by how obvious the error would be to the patient if not disclosed (more apparent vs less apparent). Five questions measured what respondents would disclose using scripted statements. RESULTS: Wide variation existed regarding what information respondents would disclose. Of the respondents, 56% chose statements that mentioned the adverse event but not the error, while 42% would explicitly state that an error occurred. Some physicians disclosed little information: 19% would not volunteer any information about the error's cause, and 63% would not provide specific information about preventing future errors. Disclosure was affected by the nature of the error and physician specialty. Of the respondents, 51% who received the more apparent errors explicitly mentioned the error, compared with 32% who received the less apparent errors (P<.001); 58% of medical specialists explicitly mentioned the error, compared with 19% of surgical specialists (P<.001). Respondents disclosed more information if they had positive disclosure attitudes, felt responsible for the error, had prior positive disclosure experiences, and were Canadian. CONCLUSIONS: Physicians vary widely in how they would disclose errors to patients. Disclosure standards and training are necessary to meet public expectations and promote professional responsibility following errors.

Attitude of Health Personnel↗
PubMedDate not supplied

US and Canadian physicians' attitudes and experiences regarding disclosing errors to patients.

BACKGROUND: Patients are often not told about harmful medical errors. The malpractice environment is considered a major determinant of physicians' willingness to disclose errors to patients. Yet, little is known about the malpractice environment's actual effect on physicians' error disclosure attitudes and experiences. METHODS: Mailed survey of 2637 physicians (62.9% response rate) in the United States (Missouri and Washington) and Canada, countries with different malpractice environments. RESULTS: Physicians' error disclosure attitudes and experiences were similar across country and specialty. Of the physicians, 64% agreed that errors are a serious problem. However, 50% disagreed that errors are usually caused by system failures. Ninety-eight percent endorsed disclosing serious errors to patients and 78% supported disclosing minor errors; 74% thought disclosing a serious error would be very difficult. Fifty-eight percent had disclosed a serious error to a patient, and 85% were satisfied with the disclosure, and 66% agreed that disclosing a serious error reduces malpractice risk. Respondents' estimates of the probability of lawsuits were not associated with their support for disclosure. The belief that disclosure makes patients less likely to sue (odds ratio, 1.58), not being in private practice (odds ratio, 1.47), being Canadian (odds ratio, 1.43), and being a surgeon (odds ratio, 1.26) were independently associated with higher support for disclosing serious errors. CONCLUSIONS: US and Canadian physicians' error disclosure attitudes and experiences are similar despite different malpractice environments, and reveal mixed feelings about disclosing errors to patients. The medical profession should address the barriers to transparency within the culture of medical and surgical specialties.

Attitude of Health Personnel↗