A report in the October Issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals, reveals that pediatricians have a wide range of approaches towards disclosing medical errors to patients and their families. To be more specific, they may be less likely to disclose this information if the errors are less obvious to parents.

Admitting error “may prove to be an exceptionally challenging conversation,” the authors of the report write. That’s why many doctors avoid telling their patients the truth if a medical error happens. Pediatricians make no exception to the rule, the survey performed by David J. Loren, M.D., of the University of Washington School of Medicine, Seattle and colleagues, found.

The survey included 11 questions about one of the two situations, which were randomly assigned. One of the situations described how a pediatrician administered an overdose of insulin resulting in admission of the child to the intensive care unit, an outcome clearly observable by the family. The second situation involved a physician who failed to follow up with one of the patient’s laboratory tests, eventually resulting in an infection and subsequent hospitalization, an outcome considered less obvious to parents.

The survey, conducted at the University of Washington in Seattle and Washington University in St. Louis, involved 369 pediatricians but only 205 responded. The responding population was made up of 176 attending physicians and 29 trainees. Overall, the study found: 53 percent of the respondents said they would definitely disclose the error; 40 percent said they would probably disclose the error; 14 percent said they would disclose the error only if asked by the parent; 46 percent said they would use the word “error” when disclosing the information; 54 percent said they would include an explicit apology which acknowledged the harm caused to the child and 50 percent said they would explain detailed plans for the prevention of future errors.

“This study demonstrated marked variation in when and how pediatricians might disclose medical errors and found that they may be less likely to disclose an error that was less apparent to the family,” the authors write. And this happens although parents have clearly expressed their desire to be informed about errors in the medical care of their children. What leads pediatricians to hide the truth? Fears of malpractice, shame or embarrassment are three examples involved in most cases.

The findings are similar to what happens in other specialties that have been surveyed, internal medicine physicians and surgeons specifically, Dr. Loren said. But when it comes to kids, the implications are more serious, as medical errors could have long-term repercussions in their case.

The study was funded by the Agency for Healthcare Research and Quality, the St. Louis Children’s Hospital and the Seattle Children’s Hospital and Regional Medical Center.