사람들은 무엇 때문에 실수를 받아들이지 않는가? 의료과오를 드러내는 것에 관한 요인설문조사(factorial survey)

사람들은 무엇 때문에 실수를 받아들이지 않는가? 의료과오를 드러내는 것에 관한 요인설문조사(factorial survey)

What makes an error unacceptable? A factorial survey on the disclosure of medical errors

DAVID L. B. SCHWAPPACH AND CHRISTIAN M. KOECK

University Witten/Herdecke, Health Policy & Management, Witten, Germany

배경: 환자에게 의료과오에 대해 밝히는 것이 중요하다는 것에 대해서 논쟁이 있지만, 그 과오를 다루는 것과 관련된 여러가지 특성과 그 과오에 대해서 환자와 의사소통 하는 것이 미치는 영향에 대해서는 알려진 바가 별로 없다.

Background. Although the importance of disclosing medical errors to patients has been argued, little is known about the relative effect of different attributes of error handling and communication on patients’ judgments about errors.

목적: 의료과오의 다양한 특성과 그 후 의사가 그 의료과오를 어떻게 다루는가가 환자가 그 사건을 판단하는데 미치는 영향을 살펴보았다. 또한 이러한 환자의 태도가 그 이후의 결과에 대한 환자들의 태도, 그리고 의사들에 대한 처벌에 대한 태도에 어떤 영향을 미치는지를 보았다.

Objectives. This study investigates how different characteristics of medical errors and of physicians’ subsequent handling of errors contribute to patients’ evaluations of the incident and their attitudes towards potential consequences and sanctions for the physician.

방법: vignette technique를 이요한 factorial survey를 활용하였다. 인터넷을 활용하여서 일반 대중에 대한 의료과오 상황을 포함한 가상적 시나리오를 제시하였다. 1017명의 German Internet survey panel이 참여하였다. 

Materials and methods. A factorial survey using the vignette technique presented hypothetical scenarios involving medical errors to members of the general public in an Internet-based study. Members of a German Internet survey panel participated (n = 1017). Multiple ordered logistic regression models were estimated to explain citizens’ judgments of error severity and their attitudes towards reporting of errors, wishing for referral to another physician, and supporting sanctions against the health professional involved as a response to characteristics of the presented errors.

결과: 의료과오로 나타난 결과의 심각도가 가장 중요한 단 한가지 요인으로 나타난 가운데, 의료과오에 대한 전반적 평가와 그 이후 결과를 고려하는데 있어서는 의료진의 과오에 대한 접근방식이 중요한 것으로 나타났다. 심각한 결과를 초래하는 과오에 대해서 정직하고, 공감적이고, 책임감있는 접근이 환자가 의사에 대해 강한 책임을 물을 가능성을 낮춰 주었다. 응답자의 특성은 판단에 거의 영향을 주지 않았다.

Results. While the severity of the outcomes of errors remains the most important single factor in the choice of actions to be taken, the professional’s approach to the error is regarded as essential in the overall evaluation of errors and the consideration of consequences. In errors with a severe outcome, an honest, empathic, and accountable approach to the error decreases the probability of participants’ support for strong sanctions against the physician involved by 59%. Judgments were only marginally affected by respondents’ characteristics.

결론: 의료과오에 대해 어떻게 대처하는가가 사람들이 의료과오에 대해 어떤 행동을 취할 것인가에 큰 영향을 주었으며, 사람들은 그러한 사건을 'error'라고 부르지 않는 것에 민감한 반응을 보였다. 과오에 대한 탈개인화된(de-individualized), 시스템중심의(systems-oriented) 접근법의 성공을 위해서는 의료진이 환자에게 분명한 책무성을 보여주는 것이 중요하다.

Conclusions. The handling of errors strongly contributes to citizens’ choice of actions to be taken, and they are sensitive to failures to name the incident as an ‘error’. For the success of de-individualized, systems-oriented approaches to errors, communication of clear accountability to patients will be crucial.

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의료과오는 보건의료시스템에서 가장 심각한 질적 문제 중 하나이며, 건강 관련 유해(harm)과 상당한 연관이 있고, 경제적 부담을 초래한다. 의료과오는 환자와 의사 관계를 해칠 수 있고, 보건의료 시스템에 대한 환자의 신뢰를 저하시킨다. '인간은 실수하기 마련이다'라는 말과 과오를 예방하기 위하여 온갖 효과적인 방법을 사용하더라도 어떤 의료과오는 의료에서 불가피한 부작용이다. 과오를 예방하는 것과 별도로 보건의료직에 종사하는 사람들은 의료과오를 접근함에 있어서 환자들이 보건의료시스템에 신뢰를 잃지 않도록 하는 것이 중요하다. 많은 연구자들이 환자들에게 과오에 대하여 설명하고, 사과하고, 정직하고, 돌봄의 의사소통을 하는 것을 강조해왔다.

Medical errors are among the most serious quality problems in health care systems and are associated with considerable health-related harm and economic burden [1]. Medical errors also have the potential to compromise the physician–patient relationship and to undermine patients’ trust in the health care system as a whole. ‘To err is human’, and even if all effective measures were taken to prevent errors, the occurrence of some errors has to be accepted as an inevitable side-effect of medical care. Besides the prevention of errors, it is therefore essential that health care professionals approach errors in a way that allows patients to preserve confidence in the health care system. A number of authors have stressed the importance of disclosure of errors to patients, the role of apologizing, and the need for honest and caring communication [2,3]. 

기존의 연구를 보면 환자들은 의료 과오를 밝히는 것을 대단히 선호하며, 거기에 깔린 원인, 결과, 그리고 재발 예방에 대한 정보를 제공받고 싶어한다. 이러한 사건이 생겼을 때, 의료진이 그것을 어떻게 다루는가가 그 일을 당한 환자에게 주는 결과에 영향을 준다는 근거도 있다. 의료진에 의해서 생긴 트라우마가, 그 트라우마를 진지하고 민감하게 다루지 않는 의료진의 태도와 겹쳐지면 그 의료진에 대한 법적 대응을 할 가능성이 높아진다. 그러나 의료과오의 어떤 특징 (결과의 심각성), 이후의 의료진의 접근 어떤 접근 태도가 환자의 그 사건에 대한 평가와 이후 결과에 대한 태도에 영향을 주는가는 알려져 있지 않다. 

Empirical studies have shown that patients have strong preferences towards the disclosure of errors and the provision of information about underlying causes, consequences, and prevention of recurrences [4,5]. There is also evidence that the way the incident is handled by health care professionals influences whether and which consequences are drawn by affected patients (or their families) [6]. If the trauma of being harmed by a health care professional is followed by the trauma of not being taken seriously and communicated with sensitively, the likelihood of taking legal actions against the involved persons increases [7,8]. However, very little is known about how different characteristics of a medical error, such as outcome severity, and of the subsequent approach to this error contribute to patients’ evaluations of the incident and their attitudes towards potential consequences. We conducted a factorial survey using the vignette technique [9] that presented hypothetical scenarios involving a medical error to members of the general public. The main objective was to investigate how characteristics of the error itself and the way the error is handled relate to citizens’: (i) judgments of error severity; (ii) wishes to be referred to another physician; (iii) attitudes towards reporting of errors; and (iv) requests for sanctions for the involved health professional.

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Int J Qual Health Care. 2004 Aug;16(4):317-26.

What makes an error unacceptable? A factorial survey on the disclosure of medical errors.

Schwappach DL1, Koeck CM.

Author information

Abstract

BACKGROUND:

Although the importance of disclosing medical errors to patients has been argued, little is known about the relative effect of different attributes of error handling and communication on patients' judgments about errors.

OBJECTIVES:

This study investigates how different characteristics of medical errors and of physicians' subsequent handling of errors contribute to patients' evaluations of the incident and their attitudes towards potential consequences and sanctions for the physician.

MATERIALS AND METHODS:

A factorial survey using the vignette technique presented hypothetical scenarios involving medical errors to members of the general public in an Internet-based study. Members of a German Internet survey panel participated (n = 1017). Multiple ordered logistic regression models were estimated to explain citizens' judgments of error severity and their attitudes towards reporting of errors, wishing for referral to another physician, and supporting sanctions against the health professional involved as a response to characteristics of the presented errors.

RESULTS:

While the severity of the outcomes of errors remains the most important single factor in the choice of actions to be taken, the professional's approach to the error is regarded as essential in the overall evaluation of errors and the consideration of consequences. In errors with a severe outcome, an honest, empathic, and accountable approach to the error decreases the probability of participants' support for strong sanctions against the physician involved by 59%. Judgments were only marginally affected by respondents' characteristics.

CONCLUSIONS:

The handling of errors strongly contributes to citizens' choice of actions to be taken, and they are sensitive to failures to name the incident as an 'error'. For the success of de-individualized, systems-oriented approaches to errors, communication of clear accountability to patients will be crucial.

PMID:

 

15252006

 

[PubMed - indexed for MEDLINE] 

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