Doctors, Public Disagree on Medical Error Causes, Solutions, Survey Finds

While 35% of doctors and 42% of patients say they or a family member have experienced a preventable medical error, physicians and the public disagree on the causes of medical errors and what should be done when such mistakes occur, according to a new survey, the Washington Post reports. Appearing in the Dec. 12 issue of the New England Journal of Medicine, the survey includes responses from 831 doctors and 1,207 adults and represents the first attempt to measure the public's experience with medical errors and their opinions on how to prevent them, the Post reports. The survey, designed and analyzed by researchers with the Kaiser Family Foundation and the Harvard School of Public Health, comes after the Institute of Medicine three years ago released a report that estimated between 44,000 and 98,000 Americans die as a result of preventable medical errors. According to the survey, 7% of physicians and 10% of the public say someone in their family has died as a result of a preventable medical error, and 12% of doctors and 17% of the public reported that they or a relative experienced a serious medical mistake that caused them to miss school or work.

Kaiser Family Foundation President Drew Altman said the survey's findings serve as "significant corroborating evidence" for the IOM report. The survey indicates a high rate of "perceived substandard care" among respondents, but when asked to name the top problems facing the medical field, respondents did not list medical errors (Brown, Washington Post, 12/12). According to the survey, the public considers health insurance and prescription drug costs to be among the most important problems. Doctors surveyed said that malpractice costs, lawsuits, health care costs and problems with insurance companies were the "top issues" in medicine. "What really worries doctors is malpractice and the possibility that this information (on errors) could be used by lawyers for suits," Robert Blendon, a Harvard professor who worked on the study, said (Goldstein, Philadelphia Inquirer, 12/12).

Seventy percent of doctors and 81% of the public who had experienced an error said that doctors had "'a lot' of responsibility" for the mistake. Further, about 25% of both the public and doctors surveyed said nurses were responsible, and 22% of doctors and 43% of the public held the hospital or care facility responsible (Bowman, Scripps Howard/Nando Times, 12/11). The groups differed on what they said are the underlying causes of medical errors. When given a list of 10 possible causes of an error, 53% of doctors surveyed blamed errors on the nursing shortage, and 50% held "overworked, stressed or fatigued" health care workers responsible (Davis, USA Today, 12/12). Seventy-two percent of the public surveyed considered "insufficient time spent by doctors with patients" as the chief cause of medical errors (Washington Post, 12/12). Seventy percent of the public also blamed medical errors on overworked health care workers, 76% said health care workers not communicating as a team lead to errors, and 65% cited the nursing shortage (USA Today, 12/12).

As far as how to reduce medical errors, 75% of the public and 33% of doctors said only allowing specially trained doctors to work in intensive care units is an effective way to prevent errors, the survey found (Washington Post, 12/12). The public also was much more likely than doctors to believe that increased use of computerized medical records and computerized systems to order diagnostic tests and drugs would improve patient safety, according to the survey (Scripps Howard/Nando Times, 12/11). The Post reports that such systems have been shown to reduce errors by more than 80%. "It's absolutely staggering to me" that the value of such systems is not recognized, Blendon said. "At Harvard, it is like giving water to people who are thirsty: Everyone agrees it works," he added (Washington Post, 12/12). The study said the scientific proof will be needed to convince physicians of the efficacy of proposed error reduction strategies (Blendon et. al., "Views of Practicing Physicians and the Public on Medical Errors," New England Journal of Medicine, 12/12).

The survey also asked doctors and the public whether serious medical errors should be reported. While both doctors and the public said errors are rarely reported and if they are reported, they are unlikely to lead to lawsuits, the two groups did not agree that errors should be reported (USA Today, 12/12). Seventy percent of the public and 25% of doctors said medical mistakes should be reported to a state agency (Washington Post, 12/12). Also, 62% of the public said medical error reports should be publicly disclosed, compared with 14% of physicians (USA Today, 12/12). Given that doctors are "supersensitive" to the threat of malpractice litigation, Blendon said they will be "supersensitive" to error reporting. Mollyann Brodie, director of Public Opinion and Media Research for the Kaiser Family Foundation, said, "[T]here are some big challenges particularly with doctors who do not think some of the proposed solutions would help reduce errors, and the fear of public disclosure because of the malpractice issue could limit the ability to make changes that would reduce errors" (Philadelphia Inquirer, 12/12). The study is available online.

In related news, CMS, the American Hospital Association, the Association of American Medical Colleges, the Federation of American Hospitals and the Joint Commission on Accreditation of Healthcare Organizations are launching a voluntary hospital reporting initiative this month designed to provide the public with information on hospitals and help standardize data and data collection systems to improve patient safety. The project also will help efforts to improve care and provide hospitals with a sense of the public's "reporting expectations." Under the initiative, all participating organizations will use a common set of medical conditions or aspects of care for reporting and measuring hospital care (Federation of American Hospitals release, 12/12).