To err can be fatal

Inlander, Charles B

I have mixed feelings about the recent report on medical errors in hospitals. As you probably heard, the nonprofit Institute of Medicine found that between 44,000 and 98,000 hospitalized patients die each year because of medical mistakes.

The report caused a great deal of hoopla when it was released. President Clinton called for a war on medical errors and suggested a private/public partnership to solve the problem. Sen. Edward Kennedy (D-Mass.) vowed to introduce legislation that would create a National Center for Patient Safety-something the report recommends. This will gather data on medical errors and work to correct them.

You’d probably think that a consumer health advocate like me would be elated by the report and all this activity. And I am. Sort of. But there are a number of things about the report and the proposed solutions that bother me.

Let’s begin with its title: “To Err Is Human.” The authors are essentially saying that we have to accept the fact that everybody makes mistakes-including doctors. They suggest that the solution is not to blame those who make the mistakes but to correct the systems that allow those mistakes to happen.

Well, I’m not so sure. I know doctors are human. And yes, we have to make sure that there are good systems of management that will, for instance, prevent two very different medications from having similar names. But stacks of studies show that up to 6 percent of all doctors are alcoholics, another 5 percent are addicted to drugs, and 3 or 4 percent more are outright incompetent. Yet once a doctor gets a license to practice, he’s never again examined for competence. So although I know that to err is human, I also know that, in medicine, to err can be fatal. And those who commit those errors must be held accountable.

Nor will a National Institute on Patient Safety accomplish much. We already have scores of federal agencies concerned with health. Most of them already know the data issued in the report and have for years. Do we need still another agency to gather data and not have the power to make change? I don’t think so.

To address the issues raised in this report, I think that a number of actions must be taken. We must pass state laws requiring hospitals to report their infection and drug error rates each and every year. They should tell us the names of doctors whose privileges have been suspended or revoked. We should know the mortality and complication rates, by procedure, at each facility. I think hospitals even should be required to videotape all surgical procedures-for the same reason we have black boxes on airplanes. And when a doctor or hospital is repeatedly found incompetent, we should boot him out or close its doors.

Of course, this “new” report is old news to those of us at the People’s Medical Society. We’ve been reporting the same statistics to you since the early 1980s. In our book Take This Book to the Hospital With You, we note this high, and horrendous, error rate. Our 1989 book Medicine on Trial was an examination of medical errors, and not just in hospitals. It caused such a ruckus that the American Medical Association (AMA), the trade association for doctors, issued what it called an “Adverse Commentary Alert” to its state and local chapters in which it not only challenged the book but also advised members of ways to counter our claims. Ironically, when the Institute of Medicine report was issued, the AMA acknowledged the problem but suggested that it could best solve it.

The Institute of Medicine report agrees with an assessment we made more than 10 years ago: that medical errors are the leading cause of death in the United States. But the solutions it proposes are too weak and will prove ineffective. It’s going to take individuals such as you and organizations such as the People’s Medical Society to force change.

As individuals, we must hold our doctors and local hospitals accountable. That means asking questions and demanding answers. It means putting pressure on state legislators to pass mandatory disclosure laws that force facilities and practitioners to publicly report important outcome and safety data. It means being a demanding customer. You cannot accept what your doctor or hospital does on blind faith.

It’s taken a long time for the medical establishment to acknowledge what we’ve been saying all along. And now that they agree, we cannot let them co-opt us by simply holding a few hearings and creating another federal agency.

Copyright People’s Medical Society Feb 2000

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