Review Question - QID 106592

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Ethical Principles Other Principles Many patient encounters necessitate a combination of the above ethical principles--a few general principles include: QID: 106592 (M1.ST.15.73)

QID 106592 (Type "106592" in App Search)

A junior orthopaedic surgery resident is completing a carpal tunnel repair with the department chairman as the attending physician. During the case, the resident inadvertently cuts a flexor tendon. The tendon is repaired without complication. The attending tells the resident that the patient will do fine, and there is no need to report this minor complication that will not harm the patient, as he does not want to make the patient worry unnecessarily. He tells the resident to leave this complication out of the operative report. Which of the following is the correct next action for the resident to take?

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Disclose the error to the patient but leave it out of the operative report

1/80

Disclose the error to the patient and put it in the operative report

30%

24/80

Tell the attending that he cannot fail to disclose this mistake

52%

42/80

Report the physician to the ethics committee

4/80

Refuse to dictate the operative report

0/80

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If a resident has a concern about the care he or she is asked to deliver, the resident has a duty to discuss the concern with the attending.

In the presented case, an error has occurred which may potentially harm the patient. Because there is potential for harm due to this mistake, the medical team has a duty to disclose this error to the patient. Resident physicians have an ethical duty to not simply "follow orders." Rather, residents have a duty to raise any concerns that the resident has about the care that he is asked to deliver.

Brazeau discusses reporting physician errors to patients. Truth-telling and apologizing can be healing for both the physician and the patient. In cases where damages have occurred, it can help patients to understand what happened to them and can also ease the possibility of appropriate compensation for damages, potentially avoiding larger costs in litigation. However, as much as truth-telling is the desired goal, physician fears of lawsuits and fear of damage to the doctor-patient relationship can make it difficult to tell the truth in some situations.

Snyder et al. discuss ethical issues relevant to this question. The rules for truth-telling are derived from the ethical principle of respect for autonomy. Physicians should disclose any information about procedural errors that are relevant to the patient's well-being. Additionally, Snyder states that the resident physician training environment must encourage and permit trainees to discuss any ethical issues that they encounter.

Incorrect Answers:
Answer 1: It would be inappropriate to leave this error out of the operative report.
Answer 2: While ultimately these actions should be taken, it would be inadvisable to disclose the error to the patient and include it in the operative report without first discussing this with the attending.
Answer 4: It would be premature to report this matter without first discussing it with the attending.
Answer 5: Again, the resident has a duty to discuss his concerns about patient care with the attending.