On Clinical Errors in Geriatric Medical Diagnoses: Ethical Issues and Policy Implications
Inelmen, E. M., Sergi, G., Enzi, G., Toffanello, E. D., Coin, A., Manzato, E., Inelmen, E., Ethics & Medicine
Errare umanum est sed perseverare est diabolicum
To err is human but to persist is diabolical.
Today one out of six American physicians faces a malpractice suit. The prevalence of legal actions in Europe is growing, and "Defensive Medicine" is becoming an endemic phenomena. A risk-averting practice is consequently creating an "ethical dilemma" in medical circles. Physicians faced with the risk of being punished for potential diagnostic errors may restrain from complying with the professional codes imposed on them. Diagnostic error in clinical practice is a serious public health problem that the authorities must face. According to post-mortem reports, the frequency of misdiagnosis, which ranges between 30% and 40% of cases, has not decreased in recent decades. There is a correlation between misdiagnosis and increasing age; i.e. medical errors are even more common in geriatric settings. The purpose of the present review is to focus on the causes and consequences of medical errors, and on research in this area, with a view to recommending policies capable of mitigating the risk of diagnostic errors in geriatrics. Physicians are faced with "ethical dilemmas" in their professional practice, and, while some errors are unavoidable, strategies to improve medical performance need to be adjusted continuously. Formulating detailed diagnostic protocols, limiting working hours, using computerized systems, taking a more appropriate approach to the problem of diagnostic errors in medical student training, and increasing the number of necropsies performed in geriatric patients are some of the policies that might be recommended, as discussed in this paper.
Key words: ethical dilemma, legal issues, defensive medicine, policy recommendations
Medical errors (MEs) are a serious public health problem and a burden that almost all clinicians have to bear. The exact prevalence and magnitude of MEs is unknown, but it is probably very high.1 There is evidence of errors being under-reported. ]When MEs occur, the reaction in the medical world is most often to try and find someone to blame and to punish them.2 Fear and punishment produce not security, but defensiveness, secrecy, and anguish.2 The public generally believes that a person responsible for an error that carries serious consequences should be sued, fined, and even suspended from their professions.3
In their professional activities, physicians face the risk of being involved in the death of a patient and of consequently being punished; this poses "ethical dilemmas". Medical practitioners have to cope with situations of conflict arising between the medical regulations and their own professional future. Proper legal safeguards must be in place to prevent the practice of "defensive medicine" (DM).
No setting is hazard-free, no medical specialty is immune, and patients are at risk no matter what their age, sex, and state of health.1 The risk of MEs is not the same in all cases, of course. Patients who are more severely ill, who need multiple procedures, and who remain in the hospital longer (as is often the case with the elderly) are more likely to suffer severely from MEs1; so, it is reasonable to conclude that errors are committed more frequently in the geriatric field.
Blendon et al. conducted a survey on the possible causes of MEs.3 The two main causes reported by physicians were understaffing of nurses in hospitals, and overwork, stress, or fatigue on the part of health professional. The top four causes of MEs considered important by the public were: physicians not spending enough time with patients; health professionals suffering from overwork, stress, or fatigue; health professionals failing to work together or communicate as a team; and understaffing of nurses in hospitals.
Sadly, diagnostic errors have received little attention in literature, especially in geriatrics, although the elderly population has been increasing in the last few decades, and MEs are becoming an "epidemic" condition. …