A lab report comes back to you after having been misplaced for over a month. What would you say to the patient and the patient's family regarding this clerical error that may have clinical implications?

"Hiding something like this is never acceptable. Of course I would inform the patient and hope we, together, could address its implications, if in fact there were any. I would also do a thorough review of how this mistake happened. It could have been someone's simple negligence or ineptness--perhaps even my own--or it may have been some perfect storm of otherwise legitimate policies that lined up to create this unintended clerical accident. Either way, it would become my responsibility to identify the cause and then take steps to prevent it from recurring."

This is a question about 'fessing up' when you should. Such mistakes can have clinical implications and even alter the course of disease or the prognosis. That being said, most patients are very good 'sports' about honest mistakes, which are going to happen when dealing with the volume today's labs navigate. As such, it's best to be honest and own any mistakes. Most checks and balances, thankfully, don't allow such mistakes to go on long enough where it makes an actual difference in the outcome, so being honest also protects you from the venom an attorney is likely to throw your way if you are caught in some type of coverup. This type of dishonesty will turn a malpractice case from bogus to legitimate, which helps no one.

"Even if it's not directly my fault, if I ordered the test, it's my responsibility to follow up on it. My policy is to inform the patient as soon as I discover the problem and then offer a perspective on whether the mistake will even affect the outcome."