Medical errors - I : The problem

Abstract

Byline: G. Swaminath, R. Raguram First, Do No Harm 'I felt a sense of shame like a burning ulcer. This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong. And yet I also knew that a surgeon can take such feelings too far. It is one thing to be aware of one's limitations. It's another to be plagued by self-doubt.'[sup] [1] Atul Gawande aptly describes the angst experienced by a doctor on discovering that the increased suffering in a patient was due to a slip-up on the part of the treating team. Medical errors can have a disastrous effect on patients, staff,[sup] and institutions. Medical errors are too often a taboo subject.[sup] They haunt the conscience of those involved and the[sup] medical personnel naturally find them difficult to discuss.[sup] [2] As a rule, hospitals and healthcare professionals profess and aim to provide the safest care possible. However, things may go wrong, harm can be done, and patients can inadvertently be hurt as a consequence of medical care.[sup] [3] Wu et al .[sup] [4] define an 'Error' as a commission or an omission, with potentially negative consequences for the patient, which would have been judged wrongly by skilled and knowledgeable peers at the time it occurred, independent of whether there were any negative consequences. Adverse events or iatrogenic injury, as a consequence of an error results in prolongation of hospital stay, morbidity or disability at discharge, or death.[sup] [5] As the definition is rather stringent, it is possible that there is an underestimation of adverse events, as many errors do not result in injury because they are caught in time, the patient is resilient or because of plain good luck.[sup] [3] These adverse events must be distinguished from unfavorable side effects, which are unpredictable or unavoidable complications that may occur during the appropriate application of the best practice, whereas, the former result from an error. To Err is Human To Err Is Human,[sup] [6] the report from the National Academy of Sciences, Institute of Medicine (2000), estimated that as many as 98,000 people die every year in the US because of mistakes committed by medical professionals in hospitals. According to the report, more people die annually from medical errors than from motor vehicle accidents, breast cancer or AIDS - the three causes that receive far more public attention.[sup] [7] In the Harvard Medical Practice Study,[sup] [8] a review of 31,429 records of patients identified an adverse event in 3.7% of the admitted patients; 43% of these adverse events caused at least moderate impairments to the patients. In 69% of these cases, the adverse events were considered preventable (implying error), as opposed to events considered to be non-preventable, that is, anticipated, but with unavoidable complications. Another study using the same method of reviewing medical records[sup] [9] found that an adverse event occurred in 16.6% of 14,179 admissions in hospitals in New South Wales and South Australia, resulting in permanent disability in 13.7% of the affected patients and death in 4.9%. This study found that 51% of the cases were due to error. Unfortunately, similar studies are lacking in psychiatric populations, with few reports published on rates of error[sup] or adverse events, and there has been little commentary[sup] on related methodological issues.[sup] [10] Some prominent psychiatric[sup] journals do not even include 'medication errors' or 'adverse[sup] drug events' as keyword options for the submitted manuscripts.[sup] [10] Among adverse event surgery forms the source in almost half of the cases, followed by complications resulting from medication treatment, therapeutic mishaps, and diagnostic errors.[sup] [3] Diagnostic errors were the most frequent non-operative errors. However, most research has focused on medication errors rather than diagnostic errors. …