Medical Errors

Surprisingly, recent research suggests that medical errors are one of the top causes of preventable deaths. Medical errors include conducting surgery on the wrong patient, giving a patient two drugs that interact dangerously, or misdiagnosing and hence mistreating a patient.

When errors occur, it is natural to focus on identifying who is to blame. Yet most errors occur despite the best efforts of health care workers. Consequently, most researchers argue that we need to shift our focus from individual errors to problematic systems. For example, many hospitals stock certain drugs only at full strength, even though the drugs must be diluted to use safely. Stock- ing these drugs in diluted form would eliminate this source of death much more effectively than trying to identify every doctor or nurse who might administer the wrong dosage. Similarly, fatal errors can easily occur when different drugs have similar names: Someone with epilepsy, for example, who receives the antifungal drug Lamisil instead of the antiepileptic Lamictal can die if his seizures continue unabated. As this suggests, most fatalities result from the combination of human error with systems that facilitate errors.

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The lack of a system for identifying deaths caused by medical errors has ham- pered efforts to prevent such deaths. During the 1950s and 1960s, hospitals rou- tinely autopsied around half of the patients who died in their care. Now, because of a combination of economic costs and fear that identifying errors might lead to malpractice claims, hospitals autopsy only around 5%, thus virtually eliminating one of medicine’s most basic tools for identifying medical errors.

Medical culture, too, makes it difficult to control medical errors. Research consistently finds that doctors rarely focus on identifying such errors. Instead, because of professional etiquette, the need to maintain good relations with colleagues, and a medical culture that values individual doctors’ right to make their own decisions, most errors are ignored, labeled unavoidable, blamed on nonmedical staff, or blamed on doctors in other divisions.

Awareness of these problems has sparked efforts to improve the situation. For example, Veterans Administration hospitals now use a computerized record system that gives nurses and doctors access to comprehensive information on their pa- tients. In addition, the record system generates bar-coded strips that are attached to each nurse, patient, and medication. Before administering medications, nurses must scan their own bar code, their patients’ bar codes, and the medications’ bar codes into a computer. The computer then checks that the nurse has the right drug for the right patient and that the drug won’t interact dangerously with any other drug taken by that patient. The federal government now provides this record system for free to all U.S. doctors who treat patients under Medicare, the federally funded insurance program for elderly and permanently disabled individuals.