Should you disclose a significant medical error, such as a 10-fold insulin overdose, to the patient?

Should You Disclose a Significant Medical Error to the Patient?

Yes, you must disclose significant medical errors, including a 10-fold insulin overdose, to the patient or their representative in a timely fashion. This is not optional—it is an ethical and professional obligation supported by multiple medical organizations and guidelines.

The Clear Mandate for Disclosure

The American College of Emergency Physicians explicitly states that if an emergency physician determines an error has occurred that causes significant harm or alters a patient's needs for care, they should provide information about the error and its consequences to the patient or their representative in a timely fashion, in accordance with hospital policy 1. The Association of Anaesthetists of Great Britain and Ireland reinforces this, stating that any incident causing patient harm must be disclosed to the patient or their next of kin in accordance with local policy 1.

What Patients and Families Want

Patients and families consistently want three things when an error occurs:

• An honest explanation about what happened 1
• A sincere apology 1
• Information about what will be done to prevent recurrence 1

Studies clearly demonstrate that patients share a nearly universal preference for complete disclosure of incidents, regardless of age, gender, or education 2. This includes personal, timely, and unambiguous disclosure of the adverse event, information about its causes and consequences, and an expression of regret 2.

The Disclosure Process

Your disclosure should include:

• Timely explanation of the facts: What happened (10-fold insulin overdose was administered), when it occurred, and who was involved 3, 4
• Acknowledgment of harm: Be transparent about the potential consequences, including the risk of severe hypoglycemia which can cause seizures, coma, and even death 5, 6
• Expression of regret and apology: Take responsibility and express sincere remorse 3, 4
• Immediate management plan: Explain what is being done now to monitor and treat the patient (frequent glucose monitoring, treatment protocols for hypoglycemia if it occurs) 7
• Prevention measures: Describe what will be done to prevent this from happening to others in the future 1

Managing the Insulin Overdose Specifically

For this 10-fold insulin overdose, your immediate clinical actions must include:

• Intensive glucose monitoring: Implement frequent blood glucose checks, as hypoglycemia from insulin overdose may require continued observation and additional carbohydrate intake even after apparent clinical recovery 5
• Treatment readiness: Have oral glucose, glucagon, and IV dextrose immediately available, as severe episodes may require intramuscular/subcutaneous glucagon or concentrated intravenous glucose 5
• Extended observation: Monitor for prolonged periods, as insulin overdose can cause delayed and recurrent hypoglycemia 5

Common Barriers and How to Overcome Them

Healthcare professionals face substantial obstacles to disclosure, including fear of litigation, shame, and concern about reputation 1, 4. However, poor communication and lack of transparency are actually the primary drivers that cause patients to file lawsuits 4. Paradoxically, honest disclosure may reduce rather than increase legal risk.

Key points to remember:

• The majority of healthcare professionals support honest disclosure, but many lack training in how to do it properly 2
• Many institutions now have policies and educational programs specifically for error disclosure 1
• Risk managers and hospital attorneys are often supportive of appropriate disclosure efforts 1

Institutional Support Requirements

Your healthcare organization should:

• Have established policies and procedures for identifying and responding to medical errors 1
• Provide support systems for healthcare workers involved in errors, as they often experience acute distress and intense emotional responses 2
• Implement continuous quality improvement systems to learn from errors 1
• Report the incident to both local and national incident reporting systems 1

Critical Pitfall to Avoid

Never delay disclosure hoping the patient won't experience harm. Insulin errors, particularly 10-fold overdoses (often caused by writing "U" instead of "units"), are well-documented causes of severe hypoglycemia, seizures, coma, and death 6. The serious consequences of insulin overdose make immediate disclosure and intensive monitoring non-negotiable, even if the patient appears stable initially.