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Electronic Letters to:

David M. Studdert, Michelle M. Mello, Atul A. Gawande, Troyen A. Brennan, and Y. Claire Wang Disclosure Of Medical Injury To Patients: An Improbable Risk Management Strategy Health Affairs, January/February 2007; 26(1): 215-226. [Abstract] [Full Text] [Figures Only] [PDF] [Technical Appendix] [Reprints & Permissions]

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Disclosure: More Than The Right Thing to Do

Lee Taft   ( 21 February 2007 )

Disclosure: More Than The Right Thing to Do 21 February 2007
Lee Taft, Educator and Consultant J.D., M.Div. Send letter to journal: Re: Disclosure: More Than The Right Thing to Do leetaft{at}earthlink.net Lee Taft	David Studdert and colleagues raise an important issue regarding disclosure and its potential impact in prompting previously unreported claims. Their methodology has been critiqued by many in the disclosure movement, particularly those who see disclosure primarily as a utilitarian tool for risk managers. Apparently those critics failed to note the authors' own disclosure regarding the limits of their research. I write to highlight some key points that were not included in the discussion. First, disclosure is not a regulatory, ethical, and, in some states, statutory requirement because of its efficacy as a risk reduction strategy. Nor is it so regulated simply because it is the "right thing to do." Rather, it is required as an element in informed consent and its potential to enhance patient safety. Second, the authors have understated the potential impact of disclosure. If disclosure leads to effective prevention strategies as the authors' note, the potential pool of future claimants should be substantially reduced. Another point that should be investigated is the importance of proactive claim identification, which disclosure inspires, and the opportunities this creates for early intervention, mediation, and reconciliation programs. Finally, and critically, attention should be paid to the healing opportunity disclosure provides for both patient and provider. I have elaborated this concept in my own essays on apology and its role in the disclosure of unanticipated outcomes. Here I simply underscore the moral dimension of disclosure, especially when it is tied to substandard medical care.