Original Research We need to talk: Provider conversations with peers and patients about a medical error Tejaswini Dhawale 1 , Jennifer Zech 2 , Sarah M Greene 3 , Douglas W Roblin 4 , Karen Berg Brigham 1 , Thomas H Gallagher 1 and Kathleen M Mazor 5 Abstract Purpose: Although open communication with patients is the established best practice after a medical error, healthcare providers’ conversations with each other in these circumstances are less studied. We identified and compared what providers identified as the most important thing to say to their peer and to the patient after a medical error. Methods and materials: This study surveyed providers about the most important thing they would say to their peers and patient regarding a hypothetical scenario depicting a delayed diagnosis of cancer. Participants included primary care physicians, oncologists, and oncology nurses. Direct content analysis was used to identify major themes and the McNemar test was used to evaluate significant differences in the providers’ references to major themes (p > 0.05). Results: A total of 303 providers produced valid responses. Four major themes emerged: (1) information sharing; (2) emotion handling; (3) preventing recurrences; and (4) responsibility. While the majority of provider responses included information sharing, fewer than one-third described the event as an error. Significantly, fewer providers addressed emotion with their peer than with the patient (10% vs. 54%, p  0.001). Providers were more likely to bring up prevention of recurrences with their peer than with the patient (43% vs. 19%, p  0.001). Approximately one- quarter of providers addressed responsibility with the peer and patient (25% vs. 26%, p ¼ 0.707), although fewer than 10% acknowledged personal responsibility for the error in either context. Conclusion: Providers approach conversations about medical errors with a peer differently than with patients and may benefit from additional communication training or support. Keywords Provider conversations, peer conversations, medical error, communication, delayed diagnosis Introduction When a medical error occurs, two distinct sets of chal- lenging conversations become necessary: among the involved providers and with the patient. When multiple providers are involved, conversations between physi- cians clarify what happened and how best to approach the patient. 1 Substantial research has addressed what providers should say to patients about a medical error, but little is known about conversations about errors among providers. 1–5 While both types of conversations can reveal details about the event and have strong emo- tional undertones, they can be expected to be different given the distinct types of relationships (professional vs. therapeutic) involved. After a medical error, 1 Center for Scholarship in Patient Care, Quality and Safety, University of Washington, Seattle, USA 2 Mailman School of Public Health, ICAP at Columbia University, New York, USA 3 Health Care Systems Research Network, Seattle, USA 4 Mid-Atlantic Permanente Research Institute, Rockville, USA 5 Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, USA Corresponding author: Tejaswini Dhawale, UWMC Health Sciences, University of Washington, BB1240, Campus Box #356526, 1959 NE Pacific St., Seattle, WA 98195, USA. Email: tdhawale@uw.edu Journal of Patient Safety and Risk Management 2019, Vol. 24(4) 140–146 ! The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2516043519863578 journals.sagepub.com/home/cri