Professionalism, error disclosure and quality in pain practice

Be honest with patients about errors whatever the liability worry, know that industry payments to you are reported to CMS and made public, and use professional interpreters for patients with limited English.

1. Disclose errors, even without harm. AMA Opinion 8.6 says patients have a right to know conditions that may have resulted from error; even when treatment will not change, involved physicians should disclose it, explain potential harm and give information for future decisions ¹.
2. Liability concerns do not change the duty. The opinion states that concern about legal liability should not affect the physician's honesty with the patient ¹.
3. Disclosure has defined components. Physicians should acknowledge the error, express compassionate concern, explain prevention efforts, and provide continuity of care, including transfer if the patient has lost trust ¹.
4. Industry payments are public. Under Open Payments, reporting entities such as drug and device companies report payments to covered recipients such as physicians; CMS publishes the attested data in a public database ².
5. Clinicians review, companies report. Covered recipients, including physicians, advanced practice providers and teaching hospitals, can review and dispute data before publication; CMS publishes it annually, exactly as received ³.
6. Quality is a shared professional obligation. AMA Opinion 1.1.6 asks physicians to ensure care is safe, effective, patient centered, timely, efficient and equitable, monitoring their own care through case review, peer review and quality improvement tools ⁴.

Language barriers: professional interpreters, not family members, improve communication, outcomes and satisfaction and bring care for limited English proficiency patients close to that of patients without language barriers ⁵.

• AMA defines an error as an unintended act, omission, or flawed system or plan that harms or could harm a patient ¹.
• A physician who discovers another clinician's error should encourage that person to disclose and report impaired or incompetent colleagues ¹.
• AMA supports confidential, legally protected error reporting and root-cause analysis that leads to prevention ¹.
• CMS does not judge which industry relationships are beneficial or conflicts of interest; the data are open to interpretation ².
• Reporting entities may submit data from previous years, so CMS advises clinicians to check their records every year ³.
• AMA Opinion 1.1.6 also asks physicians to keep current with best practices and maintain professional competence ⁴.
• Withholding pertinent information without the patient's knowledge or consent is ethically unacceptable except in emergencies ¹.

• Believing physicians file their own Open Payments reports; manufacturers report, and physicians review ²³.
• Skipping disclosure because the error caused no harm or will not change treatment ¹.
• Assuming Open Payments data are confidential ².
• Treating quality as solely an institutional job; AMA says responsibility is shared but the physician's role is essential ⁴.