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Barriers to medical error reporting and disclosure by doctors: a bioethical evaluation

A Research report submitted to the Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, in partial fulfillment of the
requirements for the degree of Master of Science in Bioethics and
Health Law.
Johannesburg, 2017 / Medical errors that occur in public sector hospitals should be discussed with
patients and notified to specific structures to improve systems and patient
safety. To elucidate barriers to doctors reporting errors and to establish
correct ethical requirements, a mixed methods approach was used. A
normative literature-based analysis was done to determine the correct ethical
processes taking into account South African legislation. In addition a
questionnaire-based internet survey (using REDCap) was conducted at the
School of Clinical Medicine (SOCM) at the University of the Witwatersrand
which examined the current situation and attitudes towards medical error
There were 211 clinicians who completed the survey. Public sector hospital
staff shortages and patient overloads (96%) as well as poor record-keeping
systems (89%) were identified as important reasons for errors. Fears of
victimization by colleagues (59%) and medico-legal consequence (56%) were
prominent as reasons not to disclose medical errors. Poor reporting systems
available to doctors (66%) and insufficient support from senior staff made it
difficult for doctors to report errors. Training on correct disclosing of errors to
patients and family was seen as necessary to improve skills and facilitate
effective disclosure (94%). There was general agreement that doctors 'ought
to' disclose harmful medical errors (83%) and to a lesser degree 'potentially
harmful' errors to patients (70%).
Ethical guidelines that are appropriate for South Africa are suggested, as well
as the introduction of easier reporting systems. For disclosure, a safe
environment that protects against victimization and medico-legal prosecution
is important and legislation to support this is urgently required. Training for
doctors in correct methods for adequate disclosure and apology will assist
improving patient care. / MT2017
Date January 2017
CreatorsCarmichael, Trevor Robin
Source SetsSouth African National ETD Portal
Detected LanguageEnglish

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