Mistakes happen to every clinician. The wrong dose, the missed diagnosis, the premature discharge, the communication error, the missed signal. The question is not whether mistakes happen but how you respond when they do. Defensive medicine — denying, minimizing, hiding errors — destroys alliance and produces worse outcomes. Honest disclosure usually preserves the relationship and often strengthens it.
Acknowledge to yourself first. Before disclosure to anyone else, see the mistake clearly. What did you do? What should have happened? What were the contributing factors — fatigue, system issues, your own gaps in knowledge or attention? Honest self-acknowledgment is what allows productive disclosure.
Consult colleagues. Many mistakes benefit from second-opinion review — was this actually a mistake, or a reasonable judgment that didn't work out? Was the harm significant or trivial? What's the appropriate response? Consultation protects against both over-disclosing trivial errors and under-disclosing significant ones.
Disclose to the patient when appropriate. Significant errors that affect the patient warrant honest disclosure: "I want to tell you about an error. I prescribed the medication at the wrong dose. You've taken it for a week. I want to talk through what happened, what to do now, and to apologize." Direct. Honest. Specific. Take responsibility.
Most patients respond well to honest disclosure of meaningful errors. Some patients become more trusting after honest acknowledgment — they understand they're working with a clinician who will tell them the truth even when it's uncomfortable. Alliance often survives or strengthens.
Address consequences clinically. Correct the prescription. Monitor for harm. Engage other specialists if needed. Document the error specifically — what happened, when you realized, what you did. Don't alter prior records; that compounds the original error and creates legal exposure.
Risk management and possibly legal counsel for significant errors. Most institutions have protocols. Use them. Apology laws in many states protect honest disclosure from being used as legal admission of liability.
Learn from the error. What system change, what knowledge gap, what attention failure produced it? What would prevent recurrence? The error that produces learning is less bad than the error that gets hidden and recurs.