Malpractice System Is Just Bad Medicine

The Register Guard (Eugene, OR), December 29, 2002 | Go to article overview

Malpractice System Is Just Bad Medicine


Byline: WINSTON MAXWELL For The Register-Guard

JERRY SAGEN, in his Dec. 15 Commentary article, highlighted medical errors as a cause of rising malpractice insurance costs. I feel that many of his statements and conclusions are incorrect or misleading.

I have recently retired after 40 years of medical practice, for the most part as a specialist in internal medicine. I have followed with interest the issues of medical errors, adverse outcomes from treatments and malpractice litigation. Several points need to be made.

1) Some mistakes will happen. Medical errors are inevitable, and proportional to the number and complexity of medical acts - such as obtaining medical histories, performing physical examinations, conducting laboratory examinations, making diagnoses and providing treatments with surgery, medications, or other modalities.

To get an idea about the possible number of errors that could occur in the medical care system per year, consider these statistics: There are 281 million people in the United States, and 772,296 doctors of medicine and osteopathy. In the year 2000 there were 34,891,000 hospital admissions and a daily patient census of 657,000. If each doctor did only 10 medical acts a day and worked 160 days a year, the number of medical acts a year would be 1.232 trillion. Each act is at risk for error.

2) Some deaths will happen, too. Sagen quoted statistics to the effect that 100,000 people die in hospitals each year because of preventable errors. Researchers are arguing about the validity of such numbers, but let's take it at face value for the purpose of the point I wish to make.

One hundred thousand deaths occur for each 34.9 million admissions. This is one death for every 349 admissions, or 0.3 percent. The percentage of these deaths is likely to be higher among people who are older, very sick or both, because these people require more treatments and are more vulnerable to medical errors.

3) Errors can and should be reduced. Whatever the number, it is too high. Error reduction technology such as has been used by the aviation industry focuses not on human error but on the environment in which one makes decisions. I imagine, for example, that most of the errors that a pilot could make in the cockpit of an airliner are countered by a system that alerts him or her of the error. These systems to reduce the consequence of human error are in development in the medical field.

An example is the computerized record being implemented by PeaceHealth in its hospital and clinics. In this system, the doctor writes the prescription by choosing a drug from a computer menu, which is in the consultation room; the usual instructions are already written. If there is a potential reaction with any of the medications the person is already taking, the computer alerts the doctor. When the final decision is made, the computer faxes the pharmacy or prints out a copy for the patient to take to their pharmacy. This technology is improving and in time should be a general standard of care.

4) Doctors strive to reduce errors. In a technical field such as medicine, it is the doctors themselves that have the expertise to evaluate the quality of care and to implement systems for improvement.

By long-standing tradition, doctors learn from their errors and discuss their problem cases to help each other maintain and improve care. Autopsies have been invaluable in revealing mistakes of diagnosis. In training institutions, death and complication conferences are the rule. This process was normalized, and doctors were not shamed or punished for their inevitable errors; prevention of future errors by education was and is part of the process. It is interesting that most errors are not due to medical ignorance but to lapses of attention or distraction by a wrong theory of what is being treated.

Is malpractice litigation a satisfactory means of dealing with medical errors and injured patients? …

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