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Difficulty: MediumProfessionalism and Workplace Ethics

A 68-year-old man is admitted to the hospital for community-acquired pneumonia. The internal medicine resident prescribes a daily dose of levofloxacin. However, due to a calculation error, the resident orders a dose that is twice the recommended maximum. The medication is dispensed by the pharmacy and administered by the nurse. The patient experiences mild, self-limiting nausea but remains hemodynamically stable with a normal electrocardiogram. The resident discovers the error the following morning during chart review. When the resident discusses the event with the attending physician, the attending says, "Since the patient suffered no serious harm and is clinically stable, let's just adjust the dose for today. There is no need to mention this to the patient, as it will only cause unnecessary anxiety." Which of the following is the most appropriate next step for the resident?

  1. A
    Discuss the situation with fellow residents in a public hospital elevator
  2. B
    Disclose the medication error to the patient's wife to avoid causing the patient direct anxiety
  3. C
    Follow the attending physician's recommendation and adjust the dose without disclosing the error
  4. Inform the patient about the medication error and file an institutional safety reportAnswer
  5. E
    Inform the patient that the pharmacy and nursing staff made a medication administration error

Answer

The most appropriate next step is to inform the patient about the medication error and file an institutional safety report.
All medical errors that reach a patient must be disclosed to the patient, regardless of whether significant harm occurred. This maintains trust, respects patient autonomy, and fulfills professional ethical obligations. Additionally, an institutional safety report (incident report) should be filed to initiate a root cause analysis and prevent future systemic errors. A resident physician has an independent ethical duty to ensure this occurs, even if an attending physician suggests otherwise.

Step-by-Step Solution

1
Identify the ethical dilemma presented in the scenario.
A medical error occurred (overdose of levofloxacin), and the attending physician is instructing the resident to conceal it from the patient since no serious harm occurred.
Recognizing the conflict between the attending's instructions and ethical principles is necessary to determine the correct action.
2
Apply the ethical principles of medical error disclosure.
All medical errors that reach the patient must be disclosed to the patient, regardless of the level of harm caused.
Disclosure respects patient autonomy, maintains the physician-patient relationship, and adheres to the ethical duty of veracity (truth-telling).
3
Determine the appropriate administrative action following a medical error.
The resident must file an institutional patient safety incident report.
Submitting an incident report initiates a systemic review (such as a Root Cause Analysis) to identify vulnerabilities in the medication delivery system and prevent future occurrences.

Key Concept

Medical Error Disclosure and Patient Safety
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Topics

Professionalism and Workplace Ethics

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