An article of mine has been accepted by Skeptic magazine and will be published in the next few months. It is entitled: Still Unsafe: Why the American Medical Establishment Cannot Reduce Medical Errors. One of the important themes it will discuss is that systems errors are uncommon. These are errors in the delivery systems of health care, such as failing to give pre-operative antibiotics, an aspirin in the midst of a heart attack or operating on the wrong part of the body. Although the Harvard Medical Practices Studies showed that only 6% of harmful medical mistakes were of this type, error reduction efforts in this country's hospitals are based almost exclusively on preventing them.
A paper published in 2008 in the journal Surgery and written by Dr. Peter Fabri makes the point of the rarity of systems errors as applied to surgery of several types. After an extensive review of the surgical results of almost 10,000 patients in one year at the University of South Florida School of Medicine's department of surgery, Dr. Fabri found that system errors occurred only 2% of the time. The vast majority of harms to patients who underwent surgery could be traced to the mistakes of individual surgeons. This was the same conclusion that I had reached after reviewing the findings of the Harvard Medical Practice Studies which covered all fields of medicine.
The other major type of harmful error in the Harvard Medical Practice Studies was the diagnostic error. Recent reviews of diagnostic errors and their prevention have concluded that systems fixes that have been relied on for almost everything in the field of improving patient safety since 1999 are unlikely to be of much help. The problem seems to be in the cognitive processes and clinical skills used in the initial diagnostic doctor patient interaction. Electronic health records do not lend themselves to arriving at the proper diagnosis. Check lists are similarly deemed unhelpful by experts in diagnostic error prevention. Both are systems approaches. Everything has to be rethought because what causes the correct diagnosis to come to mind is unknown.
While the aims of systems methods are laudable in themselves, the use of those methods has resulted in a lost decade and a half of trying to save well over a hundred thousand people who die as a result of preventable medical errors.