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. |
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