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Review Question - QID 103610

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QID 103610 (Type "103610" in App Search)
You are the attending physician on duty on an inpatient hospitalist team. A 48-year-old patient with a history of COPD and atrial fibrillation on warfarin is admitted to your service for management of a COPD exacerbation. Four days into her admission, routine daily lab testing shows that patient has an INR of 5. She is complaining of blood in her stool. The bleeding self-resolves and the patient does not require a transfusion. Review of the medical chart shows that the patient's nurse accidentally gave the patient three times the dose of warfarin that was ordered. What is the correct next step?

Tell the patient that a mistake was made and explain why it happened

81%

52/64

Tell the patient that the blood in her stool was likely a side effect of the warfarin

6%

4/64

Do not tell the patient about the mistake as no harm was done

0%

0/64

Do not tell the patient about the mistake because she is likely to sue for malpractice

0%

0/64

Do not tell the patient about the mistake because you did not make the mistake

0%

0/64

Select Answer to see Preferred Response

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Patients must be informed of errors made by physicians or other members of the healthcare team. The most common factor leading to malpractice is poor patient-physician communication.

In this case, a clear medical error was made by a member of the healthcare team. While the patient does not have any long-term sequelae as a result of the mistake, it is important to disclose and inform patients and families of any errors that are made. This decreases the risk of litigation, and helps maintain the doctor-patient relationship.

McBride talks about the importance of confession and strategies to reduce the emotional impact of a medical error on the physician. He gives five steps that should be taken - acknowledging the mistake to the patient or family, discussing the situation with a colleague, seeking professional advice from a lawyer, reviewing one's own successes in medicine, and basic self-care.

Gallagher et al. discuss the attitudes of patients and physicians involved in a medical error. Patients state that they want to be told of any harmful error, why it happened, how the consequences will be mitigated, and how it will be prevented in the future. However, physicians stated that while they agreed that errors should be disclosed, they often avoided saying an error was made or apologizing because they were worried that might create legal liability.

Incorrect Answers:
Answer 2: This is factually incorrect, and bypasses stating that a medical error was made.
Answer 3: The occurrence of harm is not a criteria for determining whether to disclose a medical error.
Answer 4: This is untrue, as disclosing the error decreases the likelihood of being sued for malpractice.
Answer 5: Whether the medical error was made by you or someone on your medical team, it is important for the patient-physician relationship that errors be disclosed, with the physician responsible for the patient's care (i.e. the attending) present for the discussion.

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