Do No Harm

Article excerpt

Byline: Claudia Kalb

Medical errors kill some 100,000 Americans every year. How we can reverse the trend.

For more than 20 years, trial lawyer Rick Boothman defended doctors and hospitals in malpractice lawsuits. The job taught him plenty about the disconnect between the defensive behavior practiced by the medical establishment and the humane treatment patients want. So when the University of Michigan Health System needed a new in-house attorney in 2001, Boothman made an offer: hire me and revolutionize your approach. We'll be up front with patients when medical errors happen, and we'll pay quickly when a case warrants it, rather than dragging everybody into court. "It's the decent thing to do," says Boothman. A new study published in August found that since Michigan adopted Boothman's program of disclosure and compensation, lawsuits have declined and legal-defense costs have dropped by 61 percent. There's no proof that acknowledging mistakes led directly to savings, but it didn't cause a malpractice frenzy either. "The sky doesn't fall in when you are open and honest," he says.

Boothman's approach is part of an expanding push nationwide to tackle one of medicine's most complicated and agonizing blights. In 1999 the Institute of Medicine's landmark report "To Err Is Human" found that as many as 98,000 Americans die every year from preventable medical errors--a number many experts now believe is conservative. Since then, incorrect diagnoses, needless infections, drug mix-ups, and surgical mishaps have piled up as doctors face an onslaught of patients, an abundance of imperfect information, and an ill-served tradition of shaming and blaming individual practitioners when things go wrong. Health care, says Dr. Lucian Leape, a pioneer in patient safety and chair of the Lucian Leape Institute at the National Patient Safety Foundation in Boston, "remains fundamentally unsafe."

The debate over health-care reform (the first significant provisions of the new law kicked in last week) spotlighted major weaknesses in the U.S. medical system, including errors. Even before the law's passage, the Centers for Medicare and Medicaid Services--now headed by Dr. Donald Berwick, a stalwart in the patient-safety movement--announced it would no longer reimburse hospitals for the cost of preventable complications, such as bedsores and wrong-type blood transfusions. Twenty-eight states now require hospitals to report infection rates to the public. And the reform law mandates that hospitals with high infection rates will see their Medicare payments reduced by 1 percent starting in 2015.

What is clear is that the culture of medicine must change. Books recently published by Harvard's Dr. Atul Gawande (The Checklist Manifesto) and Johns Hopkins's Dr. Peter Pronovost (Safe Patients, Smart Hospitals) are calling on doctors and hospitals to institute checklists modeled on the aviation industry to improve safety. Patients are exposing harmful experiences and mobilizing on the Internet. Some doctors are humanizing the problem by talking publicly about mistakes they committed, defying the pervasive fear of lawsuits and professional shame. And hospitals are creating educational programs for staff. Harvard's Institute for Professionalism and Ethical Practice developed an interactive workshop focused on the difficult conversations that arise after mistakes occur; more than 500 doctors, nurses, and other specialists have been trained so far, and the program is now being offered to other health systems nationwide. "Everybody is interested in learning how to do better," says Dr. Robert Truog, the institute's executive director. "We're still very much on the steep part of the learning curve."

Undoing a culture is hard, especially one steeped in hierarchy and intimidation, where doctors tend to reign supreme and nurses, pharmacists, and technicians fall into the ranks below. "What underlies it is arrogance," says Pronovost, an anesthesiologist and director of Hopkins's Quality and Safety Research Group. …