Though patients expect physicians to fully disclose information about medical errors during treatment, only a certain percentage of harmful mistakes may actually be discussed with patients, according to a pair of studies released this week.

What’s more, physicians’ estimates of how likely they were to be sued did not affect whether they supported disclosing errors to patients, according to the studies released in the Archives of Internal Medicine.

The study reported that 64 percent of physicians agreed that medical errors were a serious problem. Ninety-eight percent of physicians supported disclosing major errors to patients while 78 percent supported disclosing minor errors. Fifty-eight percent had disclosed an error to a patient.

The survey, conducted by the University of Washington School of Medicine, included interviews with 2,637 physicians in Canada and the United States who had been in practice an average of 16.8 years. About half were medical specialists, 40 percent, were surgeons and 8.5 percent were family physicians.

According to the commentary accompanying the report, the current attitudes toward mistakes may diminish trust in physicians and may also increase the risk that patients will file malpractice suits.

Two senior officials with the University of Texas Medical Branch interviewed by The Daily News said that the results are not surprising, but are an indication of a major attitudinal shift from the 1980s and 1990s.

That was when large malpractice settlements routinely made headlines, culminating in a landmark report issued in 2000 by the Institute of Medicine.

Titled “To Err is Human: Building a Safer Health System,” the reports found that more than 44,000 people died annually from medical errors, sending shock waves through the medical community and changing the landscape of the doctor-patient relationship.

“It’s a very important issue,” said Karen Sexton, UTMB’s vice president and CEO for hospitals and clinics. “We took a stand five years ago that we were going to be an institution that disclosed medical errors.”

UTMB is in the process of instituting a system dubbed LifeWings in key service areas. The management accountability system is modeled after a similar system used by major airlines under which workers on the ground or in an aircraft can make a decision to halt a flight over safety concerns. Seven hundred employees have received LifeWings training at UTMB’s operating rooms. It will next be applied to the hospitals’ obstetrics units.

“We were intrigued by the airlines’ approach on how to promote a safer environment,” Sexton said. “It involved training every person in the operating rooms who comes into contact with a patient in some way, so anyone at any time can say, ‘Wait a minute, this situation could be unsafe’.”

Sexton did not divulge specific numbers when asked how LifeWings has affected performance and error reporting, saying only that it has resulted in “fewer minor incidents, such as with arm (ID) bracelets” or other pre-operation situations.

“We do track (errors) every month, and look at everything, such as not giving medication at a proper time,” she said. “This is a human-driven industry, so the more checks and balances, the less chances of human error … but patients should expect full disclosure.”

In the first study, the researchers presented physicians with one of four scenarios involving a medical error, two of which were tailored to internal medical specialists and two to surgeons.

One of each error type would be apparent to the patient, and the other would not unless physicians informed the patient about the error. For example, the apparent error involved a sponge left inside a patient during surgery; the less apparent error was an internal injury inflicted by the physician because of unfamiliarity with a new surgical tool.

Overall, 65 percent of physicians said they would disclose the error, and 29 would “probably” disclose the error while 4 percent would disclose it only if the patient asked.

“The medical profession should consider whether the culture of medicine itself represents a more important barrier than the malpractice environment to the disclosure of harmful medical errors to patients,” the authors conclude. “Increasing physician engagement in efforts to communicate openly with patients following errors and to enhance patient safety could provide a much-needed boost to patients’ confidence in the quality and integrity of the health care system.”

Howard Brody, director of UTMB’s Institute for the Medical Humanities, said that the survey indicates - finally - a more open environment in which errors can be discussed compared to 10 or 15 years ago.

“Back then the drill I saw over and over was that doctors (in hospital settings) would never disclose errors, or otherwise the risk managers would eat you alive,” Brody said. “Obviously that was wrong, because certainly the patients have the right to this information.”

Brody was very candid in an interview, saying that physicians have to be mentally prepared to accept the idea that they could make a mistake. He said it is important that medical residents go through the process by sitting in with a physician when a patient is informed about an error.

“It’s natural human instinct to think you want to find a doctor who is guaranteed never to make a mistake. Unfortunately there is no such doctor,” he said. “The problem in the old days was an environment of pervasive denial. But now we have systems in place to work on the errors.”