Disclosure practices and regulatory frameworks

disclosure: LITERATURE REVIEW

Disclosure in medical profession refers to admission of mistakes/errors by nursing/medical professionals to their patients or colleagues. There are categories to disclosure such as open disclosure or self-disclosure etc. Wu, Folkman, McPhee, and Lo (1991) defined a medical mistake as "an act or omission for which the house officer felt responsible that had serious or potentially serious consequences for the patient and that would have been judged wrong by knowledgeable peers at the time it occurred" (p. 2089). Studies reveal that doctors are reluctant to admit mistakes for various reasons. Petronio (1994 b) found that doctors are not willing to open up because disclosure of errors leads to risks of vulnerability. Admitting mistakes to colleagues might result in criticism and loss of self-esteem and disclosing errors to patients invites anger and possible lawsuits. Earliest researches in the area reveal that doctors are hesitant to disclose errors. (Bosk, 1979; Millman, 1977) in most recent articles show that medical structures do not encourage disclosure. Disclosing medical errors are specifically discouraged in court. (Hilfiker, 1984a, 1984b) Leape (1994a) reveal that although "physicians are emotionally devastated by serious mistakes that harm or kill patients" (p. 1852), they are reluctant to admit mistakes to colleagues. The reason most commonly cited for reluctance is the public image of perfection that is attached to physicians. Gorovitz (1982)

An incompetent doctor is an oxymoron since physicians are not meant to commit mistakes. Preston (1981) feels that if successes and failures are viewed with similar attitudes, doctors would be more encouraged to admit errors. Mistakes are common in this profession, it is important however to create an environment that would encourage disclosure. The law states that medical errors that might result in lawsuits must be reported. (Goodman & London, 1993), but it is interesting to note that what is seen as a mistake by a patient may not constitute an error for the physician. Petronio (1994b) found that there are risks involved in disclosing errors are two-fold: "First, the individual controls the level of risk-taking and regulates the degree of vulnerability experienced. Second, by implication, the individual is able to preserve a sense of individualism, autonomy, and personal identity" (p. 4).

In the field of disclosure, new studies are heavily focusing on self-discloser (Priest & Dominick, 1994). Self-disclosure is being researched for things such as its prevalence, truthfulness and accuracy, and depth (Wheeless & Grotz, 1976, 1977). Petronio (1994a) has focused on self-disclosure from the perspective of general boundary management theory which was developed by Altman, Vinsel, and Brown (1981). This theory sees self-disclosure in terms of management of personal boundaries instead of managing information. The theory maintains that there exist protective boundaries around every person which a person develops for self-preservation. These boundaries determine the extent to which a person would allow information to flow from himself to others. Petronio views self-disclosure in terms of privacy. The extent of self-disclosure is dependent on the extent to which a person wants to manage privacy. (Petronio, 1990)

In connection with self-disclosure, there are others who maintain that it may be resisted since it makes a person vulnerable. Rosenfeld (1979) state: "Self-disclosure may be resisted because it leads to increased self-awareness, and an individual may believe it is better to avoid acknowledging what presumed weaknesses exist" (p. 65). Specifically applying it to doctors, Leape (1994a) maintains: "Physicians typically feel... that admission of error will lead to censure or increased surveillance or, worse, that their colleagues will regard them as incompetent or careless" (p. 1852). He states that fear might also limit a person's capacity for self-disclosure and this fear includes: "fear of embarrassment by colleagues, fear of patient reaction, and fear of litigation" (p. 1852).