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Ann Thorac Surg 2005;80:399-408
© 2005 The Society of Thoracic Surgeons

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Ethics in Cardiothoracic Surgery

Should Surgical Errors Always Be Disclosed to the Patient?

^a Department of Surgery, Northwestern University Feinberg School of Medicine, Children’s Memorial Hospital, Chicago, Illinois
^b Williams College, Williamstown, Massachusetts
^c St. Louis University Health Sciences Center, St. Louis, Missouri
^d Department of Surgery and the Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina

^_* Address reprint requests to Dr Sade, 96 Jonathan Lucas St, Suite 409, PO Box 250612, Charleston, SC 29425 (Email: sader@musc.edu).

Presented at the Fifty-first Annual Meeting of the Southern Thoracic Surgical Association, Cancun, Mexico, Nov 2–4, 2004.

The first 300 words of the full text of this article appear below.

	Introduction

 
Robert M. Sade, MD
Mistakes made in the care of patients, especially in the hospital setting, have drawn a great deal of attention since the 1999 report of the Institute of Medicine (IOM), To Err is Human: Building a Safer Health System [1]. The IOM famously cited an estimate of 44,000 to 98,000 deaths a year due to medical errors—properly termed "health care errors," in my opinion, because physicians are only one of many sources of mistakes. The highly intense, complex care required by most cardiothoracic surgical patients might logically seem to provide rich substrate for the occurrence of mistakes. They undoubtedly occur, and surgeons, beginning early in the last century, have created a culture of openly admitting and discussing their mistakes during routine morbidity and mortality conferences.

Open discussion of mistakes, however, has been mostly confined to those weekly conferences; full disclosure to patients has not been as universally practiced. Much of the ethics literature suggest that the best way to handle health care errors is to disclose them fully to patients. This policy is advised in the face of rising incidence and award levels of negligence lawsuits against physicians. Does a policy of disclosure make sense? If we follow such a policy, are we taking the high road or the road to self-destruction? Are we being saints or are we being martyrs?

At the 2004 Annual Meeting of the Southern Thoracic Surgical Association, two of the Association’s luminaries, Constantine Mavroudis and Keith Naunheim, argued opposite sides of the debate. Mavroudis played the role of saint, while Naunheim suggested that, at the very least, we ought not to be martyrs.

To focus the discussion, a case was presented in which a surgical error was committed under circumstances that allowed the surgeon the opportunity safely to conceal it.

Case
Mister Sirius Lunger is . . . [Full Text of this Article]