The conversation after a medical error is one of medicine’s biggest blind spots

By Anthony Orsini, DO | Fact checked by Todd Shryock | May 18, 2026
Originally published on https://www.medicaleconomics.com/

The clinical and financial case for teaching physicians how to communicate after a medical error

Four years of medical school. Three or more years of residency. Thousands of hours of clinical training. And almost no time learning what to do when something goes wrong.

Not the textbook kind of wrong. The kind that sits in your chest and won’t let you take a full breath. A delayed diagnosis. A missed finding on a scan. A procedure that didn’t go the way it should have. And then comes the part that no one prepared you for: walking into that room and telling the patient or their family what happened.

The conversation after a medical error is one of the most consequential a physician will ever have. It affects trust, outcomes, litigation risk, and the physician’s own wellbeing. Yet almost none of us were taught how to do it. Medical schools don’t cover it. Residency programs barely touch it. Most hospitals have no formal training in place.

What the data actually show

For decades, the default approach to medical errors in most hospitals has been some version of “deny and defend.” Don’t admit fault. Let legal handle it. Limit what you say. The thinking was that transparency would open the floodgates to lawsuits.

The University of Michigan proved that thinking dead wrong.

In 2001, Michigan’s health system replaced the deny-and-defend playbook with full, honest disclosure. When errors happened, they told patients and families the truth, took responsibility, and offered fair compensation. Researchers tracked the results from 1995 through 2007 and published their findings in the Annals of Internal Medicine in 2010. Lawsuits dropped by 65%. New claims fell by 36%. The average cost per lawsuit went from $405,921 down to $228,308. Total liability costs fell by 59%.

Those aren’t marginal improvements. They happened because physicians and risk management professionals started having honest conversations with patients instead of hiding behind attorneys. And Michigan wasn’t a fluke. When four Massachusetts hospitals adopted a similar Communication, Apology, and Resolution program, only about five percent of nearly 1,000 reported safety events resulted in claims, and the approach did not trigger new litigation or increased costs. The pattern is consistent: transparency protects patients and institutions alike.

Why families sue

Research consistently shows that families rarely sue because of the error itself. They sue because of what happens after. Because nobody told them the truth. Because they felt dismissed. Because they sat in a waiting room for hours and no one came to talk to them. The anger that drives litigation almost always begins with a breakdown in communication, not a breakdown in care.

When a physician sits down, looks a family in the eye and says, in plain language, “Something happened that should not have happened, and I want to explain it to you,” the entire dynamic changes. The family still hurts. They’re still scared or angry. But they feel respected. And more often than not, that respect is what keeps them from ever calling a lawyer and starts the process of healing and even regaining trust.

The physician no one talks about

There’s another person in that room who is suffering, and we rarely acknowledge it. The physician.

The medical community has come to recognize what researchers call the “second victim” phenomenon. The guilt and shame physicians carry after being involved in an error can be overwhelming. Doctors lose sleep over it. They question their competence. Some spiral into burnout or depression. A few leave medicine altogether.

Disclosure training doesn’t just protect patients and families. It helps the physician, too. When doctors have the skills and the confidence to handle these conversations honestly, they carry less of that weight alone. They feel supported by their institution instead of abandoned by it.

Where to start

Compassionate disclosure is not a personality trait. It’s a skill. And like any clinical skill, it can be taught, practiced, and mastered.

A study in the Journal of General Internal Medicine found that 97% of physicians said they would disclose an error that caused minor harm. But when researchers looked at what actually happened, only 41% had disclosed a real minor error. Nearly one in five admitted they’d stayed silent when they should have spoken up. The willingness is there. The training is not.

A few principles can begin to close the gap. First, when a medical error occurs, the path forward begins with a clear understanding of the necessary steps. Research shows that fewer than half of physicians feel they know the proper protocol when an error takes place. Whenever possible, your first move should be reaching out to your risk management representative. This isn’t just about policy; it’s about ensuring you have a supportive framework so you can focus entirely on the person who has been hurt.

Second, understand that the real goal is to be transparent, honest and compassionate. This is to be a moment to set aside professional defensiveness and lean into human connection. When you enter the room, sit down. Meeting a patient or family at eye level is a simple act of humility that collapses the distance between you. Standing can inadvertently signal authority or a desire to leave, but sitting shows that you are present, attentive and walking this path alongside them.

Third, in these difficult conversations, words matter. Families in the midst of a crisis often find it impossible to process clinical jargon; they are searching for honesty, not a lecture. Emotions are high. Speak in plain, gentle language that honors their experience. By avoiding medical terminology, you ensure they aren’t left feeling confused or excluded from the truth of their own care.

Fourth, let your body language match your words. Your presence must also mirror your heart. Medical training teaches physicians to project confidence, to have answers, to never show vulnerability. Those instincts become the enemy in a disclosure conversation. A physician whose posture is defensive or whose pace is rushed will contradict everything coming out of their mouth, no matter how carefully the words were chosen.

Fifth, acknowledge the family’s emotions before explaining the clinical facts. Most physicians are trained to lead with information. In a disclosure conversation, the family needs to know you see their fear and their pain before they can hear anything else.

Finally, help the family understand that medical errors are rarely the result of a single person’s mistake. Explain that while checks and balances are designed to keep patients safe, there was a breakdown in that process. Reassure them that a thorough, honest review will take place to discover exactly where the system failed and what measures will be taken to ensure this never happens again. Promise them that these findings will be shared with them completely and honestly, ensuring they are never left in the dark as you work to make things right.

These are not complex techniques. They don’t require hours of training to begin practicing. But they do require intention, and they require institutions willing to prioritize them.

The question hospitals will have to answer

The regulatory landscape is making the case harder to ignore. CMS’s Patient Safety Structural Measure now requires hospitals to attest to whether they’ve implemented a Communication and Resolution Program. Those attestations will be publicly reported on Medicare’s Care Compare site, and hospitals that fail to report face reduced reimbursement.

Yet many hospitals still have nothing formal in place. Chief risk officers, medical directors and hospital leadership cannot afford to leave that gap open. The institutions that train their physicians in honest, structured error disclosure spend less on litigation, resolve claims faster, and build stronger relationships with the communities they serve.

The conversation we owe

This isn’t just a financial argument, though the finances are hard to dispute. When something goes wrong, patients and families deserve honesty. Physicians deserve the tools to deliver that honesty with skill and compassion. And hospitals need a path forward that protects their people and their mission at the same time.

We train physicians to do extraordinarily difficult things every single day. We can train them to do this, too.

Hospital leaders should be asking one question right now: if a serious error happens tomorrow morning, does every physician on our staff know how to walk into that room? If the answer is no, that is the gap to close before the next lawsuit forces the conversation.

Anthony Orsini, DO, is a practicing neonatologist and the author of It’s All in the Delivery: Improving Healthcare Starting With a Single Conversation. He hosts the podcast Difficult Conversations: Lessons I Learned as an ICU Physician. He is the founder of The Orsini Way, which provides communication training to healthcare organizations, including its Breaking Bad News® and Mastering Medical Error Disclosures programs.