The report of the Institute of Medicine, published in the United States in 1999, reverberated throughout the world. The report showed that more people in the United States die in hospitals from mistakes in the course of medical treatment (medical malpractice) than from cancer, AIDS or car accidents. Public interest generated by this finding was enormous, and medical malpractice became a “hot” issue from a social, legal, administrative and ethical perspective. It was not surprising that the intervention of the regulatory authorities was all-encompassing and swift and engendered the beginning of a profound and fundamental change, albeit slow, in the way medical practice is conducted in the United States and throughout the Western world.

Medicine is not an exact science and cannot guarantee full-proof success with respect to each and every medical procedure. Complications in medical care are sometimes inevitable, and not every error or complication necessarily constitutes medical malpractice. Numerous studies indicate that the majority of patients want to know about every complication and error, even the very smallest, that occurred during medical treatment. Nonetheless, numerous other studies show that we, the doctors, tend to conceal information from our patients and are not inclined to expose the mistakes we make. This gap, quickly detected by the patient, severely damages the trusting relationship between patient and doctor and is the basis for most of the medical malpractice suits filed against doctors. Most of the patients that file such suits express feelings of anger, bitterness, betrayal and humiliation when they sense that vital information was concealed from them. Most are even willing to admit that they would not have sued the doctor had he treated them fairly and honestly, while supplying a comprehensive and credible explanation along with a genuine apology about what had occurred.

It is every individual’s legal right “to be informed of what treatment he is about to receive and what treatment he already received – events, actions, oversights and orders that resulted in his condition after the treatment” (Judge Barak, “Hadassah vs. Gilad). Concomitantly, there is an ethical duty to inform the patient of every error that occurred in the course of medical treatment that had an effect on his health or on continued treatment. Such disclosure is fully congruent with the most fundamental ethical principles – it is for the patient’s benefit, prevents additional harm to the patient, preserves his autonomy in choosing the form of continued medical treatment and reflects the transparency and honesty required in the professional and human relationship with the patient. On a most pragmatic level, a proactive approach of initiated disclosure reduces hostility toward the doctor and the desire to sue him for medical malpractice and prevents damaging, sensational public exposure.

There are many barriers on the path to a culture of full disclosure of medical errors. The public atmosphere calls for “blaming, disgracing and punishing” doctors that erred. Doctors justifiably fear that such disclosure will cause immediate negative publicity, loss of reputation, loss of professional status, loss of patients and medical malpractice suits, as well as disciplinary and legal procedures. It is our duty to create a new approach in which doctors can freely report every medical error without necessarily standing trial. Ultimately, this is the only way we will be able to improve the level of medicine in Israel and enhance the well being of the patients entrusted to us.

• Medicine is not an exact science and it cannot guarantee the positive outcome of every medical treatment.
• Therefore, a complication in medical treatment is sometimes inevitable. A complication signifies a negative, unintentional and unexpected outcome in the course of medical treatment.
• Not every complication or error in medical treatment necessarily constitutes medical malpractice.
• Therefore, admitting a complication in treatment does not signify admitting medical malpractice.
• The patient is entitled to be informed of the medical treatment he received, as derived from the individual’s autonomy, personal will and dignity and right to know about himself/herself.
• Proper disclosure of a medical error will preserve the trust vital in the doctor-patient relationship.
• In every case of medical error that had an effect on the patient’s health or his continued treatment, the patient should be informed of the medical error.
• The patient should be informed of the medical error as soon as possible, along with an expression of empathy and sorrow for the error that occurred.
• Disclosure of a medical error should be done by the doctor in charge and include information addressing the following questions: what happened, when did it happen, how did it happen, what measures were taken so that such an error will not recur in the future.
• The disclosure should include information about the possible effect of the medical error on the patient’s health and the measures being taken to rectify the medical error.
• Taking responsibility does not constitute admission of guilt; therefore, a doctor reporting a medical error should avoid making a statement or agreeing to the fact that he, or another doctor in the medical institution, is guilty of the medical error that occurred.
• We must aim to develop appropriate rules and regulations and encourage a social and organizational culture of transparency and full disclosure to the patient in cases of errors in medical treatment.