Medical Malpractice - The Science of Making Mistakes in Medicine
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I read about an interesting study from the University of Iowa that develops a framework to examine the science of mistakes in the practice of medicine. The study was published in Science Daily back in August 2006.
The study discusses the why's and how's physicians and other medical service providers report (or don’t report) errors that cause injury to the patient.
There are three reasons the author gives for reporting errors; all seem to be related to the practitioner’s conscience. Many times when a mistake is made there isn’t just one person to point the finger at, but a “system-based problem”. I’ve seen this recently in a wrong-site surgery case. The entire surgical staff stood around and watched the doctor operate on the wrong-side of the patient. It was obvious to me, and them, that the mistake was one the entire team bore blame for. Get to bed earlier, get up earlier, drink a cup of coffee, get to the O.R. earlier and how about reading the chart.
"The physician's focus should always be on the patient, but at the moment of a medical error, we also must consider the professional who was involved in that error," Kaldjian said. "Often an error is not directly an individual person's fault, but a system-based problem. Yet disclosing errors can be a very individual issue because sometimes only one person knows about it and, as a result, disclosure becomes an individual responsibility."
Kaldjian said disclosing medical errors can contribute to three main goals of quality health care: patients deserve to know when things do not go the way they were expected, hospitals and clinics need to be aware of mistakes in order to improve patient safety, and sharing one's own medical mistake with colleagues can help educate other doctors so that they do not make the same error.
Obviously the hospital administration is a valuable part of ‘the system’ that supports the O.R. staff and it has to take responsibility for the successes and the mistakes. What this study finds are many times the mistakes go unreported due in part to a lack of feedback on how to avoid the mistake.
The research also showed that some physicians are frustrated with reporting systems set up by hospitals to encourage error reporting because there is little or no feedback.
Medicine is a competitive profession and peer pressure works against reporting errors. What I see, after 28 years of practicing and looking at medical malpractice issues as a lawyer, is a profession in which the referral system has much to do with not wanting to hang your dirty laundry out on the line. If you advertise your mistakes referrals can dry up, a fact which works against reporting of errors.
Yet, physicians also noted that talking about errors "doesn't earn you points," and that the culture of competition in medicine can discourage doctors from being straightforward about mistakes, even among colleagues.
So what works? There are three spheres of a responsible conscience that has worked but I have my doubts about whether this study’s conclusions are of any value to changing the medical system. All of these domains for motivating doctors are about conscience. And let’s face it if by your twenties you haven’t developed a conscience it’s probably too late or there are things going on in the system that are interfering with the conscience. My mother worked on developing a conscience in her kids before they want to kindergarten.
The overall domains that motivate doctors to report errors include: responsibility to patients, responsibility to self (the physician's integrity), responsibility to the profession and responsibility to the community.
This study misses the point. Medical mistakes have economic consquences to the person and system that makes the mistake. Mistakes and the economic consequences are a system wide challenge having more to do with referrals and the shame of committing an event that results in a malpractice lawsuit than the notions surrounding concepts like caring, integrity and professional responsibility. Nice try but this author won’t get the brass ring.