I’ve been looking at the issue of medical errors for a long time. First, I learned to struggle to keep my own at an absolute minimum like the vast majority of my colleagues. Second, I became a chief of staff of each of two hospitals and had to take on the investigation of errors made by other doctors in those institutions. Third, when I retired I decided to learn and write about the whole field of error detection and prevention in American medicine. An interesting recent report has highlighted an important deficiency in the nationwide pursuit of making medicine safer.
For the past twelve years, since the publication of the landmark book, To Err is Human, by the Institute of Medicine, the emphasis on detecting, tabulating, and preventing medical errors has been on those which take place in America’s hospitals.
The outpatient, or ambulatory care setting has taken a back seat to inpatient medicine. This has been an important omission. Many more doctor’s office encounters occur each year than hospitalizations. As an effort to remedy that situation, the AMA recently released a report on its summary of research by several independently working groups of scientists on errors in ambulatory care. In the words of the AMA report, “errors in ambulatory settings can be just as devastating as those in hospitals.”
Although the report is complex and there are limitations in the research that it summarizes, it concludes that the following types of errors are most common:
Medication errors such as prescriptions for incorrect drugs or incorrect dosages
Diagnostic errors such as missed, delayed and wrong diagnoses
Clinical knowledge errors such as knowledge, skill and general performance errors on the part of clinicians
Communication errors such as doctor-patient communication errors, doctor-doctor communication errors or other miscommunications between parties.
Administrative errors such as errors in scheduling appointments and managing patient records.
All but the last can be attributed to practitioner error. The first three are very resistant to the so called systems approaches. These are based on methods that are very effective in other industries such as commercial air travel and automobile making. They have been attempted in hospitals with very modest success over the last decade. The AMA authors of the report also point out that there is scant information on any effective means of preventing such errors but they are working on setting up scientific studies to find them. It’s not an encouraging picture thus far. The best thing to do is find yourself the best primary doctor you can and stick with him or her.