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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.

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.

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.