Nowadays you have to be pretty old to remember when your doctor’s word was final and he (there were virtually no shes in those days) was about as close to a deity as any human could get without being royalty. Somewhere between then and now the concept of doctors making mistakes, leading sometimes to consequences serious enough to be considered malpractice, began to attract lawyers who envisioned large profits from these mistakes.
More recently the problem of errors by members of the medical profession took a new twist. It was becoming apparent that some physicians were making more errors, more frequently than others. Although various circumstances were at play, such as the degree of risk involved in a particular specialty, the overall question was simple, if a doctor makes a mistake shouldn’t there be some way for potential patients to know about it? Janice Hopkins Tanne wrote about this question in a brief report that she called “US doctors and public disagree over mandatory reporting of errors.” It was published in the November 9, 2002 BMJ. Referring to a report from the Institute of Medicine three years earlier, which was discussed by Fred Charatan in the December 11, 1999 BMJ, she noted that it was stated that 44,000 to 98,000 Americans were killed by medical errors every year. This was followed by an article in volume 162 of the Archives of Internal Medicine for 2002 by Robinson, et al from the University of Colorado Health Sciences Center, which found that only 29% of 2000 doctors surveyed believed that the quality of medical care in the United States was a problem. But the general public evidently didn’t agree because 69% of 610 households surveyed were worried. Also, strangely, in spite of the overwhelming support of their profession by physicians, a contradiction was evident. It seems that 70% of the doctors were convinced that “reducing medical errors should be a national priority.” Eighty percent of patients agreed with this. As a matter of fact, doctors were so taken aback by the appalling number of errors being committed that they almost unanimously concluded that they needed, and wanted, more training in how to handle these errors.
Is mandatory reporting of medical errors the appropriate way to go? When the Institute of Medicine came out with its findings three years earlier its researchers thought so. It was proposed that a national agency was necessary to handle the compilation and distribution. Did doctors surveyed three years later agree? Only 24% of Colorado based, and 32% of nationwide doctors were in accord. Predictably, 60% of households were in favor. Doctors expressed concern that there is no way to define an error in many instances, and that reporting errors or adverse events could lead to many more malpractice suits. Many of these doctors had been involved in such suits (about 35%). If errors were to be routinely reported they felt that “greater legal safeguards” are essential.
Apparently coincidentally, BMJ published two more articles related to medical errors in the same issue. One involved an inquiry regarding the handling of a finding by the Middlesbrough General Hospital in the UK that 24 patients had been exposed to the same instruments used on a patient with Creutsfeldt-Jakob disease, often referred to as the human counterpart of mad cow disease. It seems that reporting by the hospital was definitely faulty in this instance since the 24 patients first became aware of the error when the story broke in the media 12 weeks later. The hospital’s excuse was that they were waiting for a decision from the government on how to contact the patients. The second article concerned an error by an in vitro fertilization unit at Leeds General Infirmary, which resulted in a white couple ending up with twins that turned out to be of mixed races. Fortunately the children ended up living in a “happy and loving environment.”
Any decision to report medical errors is fraught with positive and negative potential. Will the end result be that many physicians, those willing to take on more difficult and riskier cases, might start to back off, fearing malpractice suits and loss of patients and prestige? Will more and more lawsuits with higher and higher costs and awards be generated so that the price of medical care will skyrocket? Will these skyrocketing prices, and frightening consequences continue to drive away some of the finest candidates for the future of medicine, and to force older doctors into early retirement? Will better-informed patients, unable to fully comprehend the intricacies involved, shy away from risky but essential or life-saving procedures? In other words, when you don’t fully understand the circumstances and the consequences, is it better to be aware of the dangers involved, or is it wiser to leave the decision-making up to professionals, even if there is a distinct risk that errors might occur?
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