MEDICAL ERRORS: Even Good Docs Make Mistakes
Despite popular perceptions that most fatal mistakes are made by "bad" doctors, Dr. Atul Gawande writes in this week's New Yorker that "all doctors make terrible mistakes." The real problem, he writes, "isn't how to keep bad physicians from harming patients; it's how to keep good physicians from harming patients." Medical malpractice suits are "a remarkably ineffective remedy," asserts Gawande, pointing out that there is a lack of evidence showing "litigation reduces medical-error rates." But even worse, malpractice suits make "adversaries of patient and physician" and discourage doctors from "acknowledging and discussing" their mistakes by "demonizing errors." Gawande commends most academic hospitals' weekly Morbidity and Mortality Conferences, which provide doctors with a forum in which they can "review the mistakes, complications and deaths that occurred on their watch, determine responsibility and figure out what to do differently next time." But simply focusing on human error may not be enough, he writes, citing experts who "believe that it's the process, not the individuals in it, which requires closer examination and correction." He notes that anesthesiologists were able to drastically reduce anesthesia-related deaths by reducing the number of hours anesthesiology residents work, standardizing equipment design, introducing monitoring devices to catch errors while they are still fixable and developing crisis simulators to keep their skills sharp. Applauding additional efforts within the medical community to study how mistakes happen, Gawande asserts that nonetheless, "hard information about how things go wrong is still scarce." For example, "the lack of standardized protocols, the surgeon's inexperience, the hospital's inexperience, inadequately designed technology and techniques, thin staffing, poor teamwork, time of day, the effects of managed care and corporate medicine" may all be to blame, but the medical profession still does not know "which are the major risk factors." Gawande concludes, "No matter what measures are taken, medicine will sometimes falter, and it isn't reasonable to ask that it achieve perfection. What's reasonable is to ask that medicine never cease to aim for it" (2/1 issue).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.