To Err Is Human

Abstract

To the Editor: In their article on the relatively limited changes that have followed the 1999 Institute of Medicine (IOM) report To Err Is Human, Drs Leape and Berwick correctly argue that complexity, professional fragmentation, individualism, and hierarchical authority structures, along with vague accountability and lack of hospital or health plan leadership, create barriers to team work and individual accountability, prerequisites for a culture of safety in medicine. We wish to draw attention to the critical role that specialty societies can play in advancing patient safety. Specialty societies are ideally positioned to explore how patient safety concepts play out in their individual fields and engage their members in addressing the problem of medical errors. Although many aspects of patient safety are common across diseases, errors and adverse events have important specialty-specific dimensions. For example, in clinical oncology, there may be issues related to errors around the severity, pain, and uncertainty of the patient’s condition; the tension inherent in patient-physician communication about cancer; the complexity of cancer diagnosis and treatment; and the toxicity of many cancer therapies, coupled with the prominent role of experimental treatments. The 2005 Annual International Meeting of the American Society of Clinical Oncology offered an educational session on “Medical errors in oncology: patients’ and physicians’ attitudes and management strategies.” A narrative lecture by a journalist and patient with breast cancer was followed by the presentation of ongoing empirical research on patients’ and physicians’ attitudes regarding error disclosure. Physicians’ emotional reactions to errors committed or observed were discussed, along with the ethical implications of medical errors in oncology, focusing on team errors, errors in clinical trials, improper communication, and individual and institutional arrogance. By understanding the problem of medical errors within their specific context, specialty societies can contribute to changing the culture of medicine and to developing effective strategies for reducing errors. How to communicate with patients when harmful errors occur may also be best addressed within each specialty. Silence spoils the trust necessary to the patient-physician relationship and it negatively affects the physician’s inner life and moral integrity. Persisting cultural differences in truth-telling with patients who have cancer add to the complexity of medical errors in oncology. Research should also focus on crosscultural analysis of attitudes and practices of disclosure.