Philip Levitt, M.D. - Company Message
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hospital safety

Patient Safety Must Be Carefully Rethought

 What should doctors do to make medicine safer? The numbers of deaths from errors, by most accounts, are not improving.  The medical establishment bared its soul in a recent issue of the Journal of the American Medical Association. Instead of original research papers it consisted almost entirely of 22 opinion pieces written by a heterodox group of authors about controversies related to achieving the goal of doing no harm.

There was emphasis on a recent flap over how much didactic preparation, i.

A New Hope for Reducing Medical Errors

A study published last December in the Journal of the American Medical Association is a small bud on a nearly barren tree. That is because little progress has  been made in reducing deadly medical errors since the surprisingly high incidence of such problems was disclosed by the Institute of Medicine in 1999. The institute had recommended an approach, called systems, used chiefly in the airline and automobile manufacturing industries. but little was achieved in the fourteen years that followed despite a widespread effort to systematize American healthcare.

Are Our Hospitals Getting Safer?

          I have returned to posting on my blog after several months. Multiple other projects have kept me away.  In December, my  article for Skeptic magazine appeared in the winter quarter issue of that publication, Volume 18, Number 4. Its title is "Still Unsafe: Why the American Medical Establishment Cannot Reduce Medical Errors" and is available on the Web. Here is what a prominent medical editor and researcher who declined attribution said, " It's really well done and I am in complete agreement with you on the topic.

Lack of Insight

          As a chief of staff, I was the head disciplinary officer of the two hospitals where I served in that office. I found it nearly impossible to rein in a persistently erring doctor. The emphasis is on the word "persistently" because the other kind of doctor makes a mistake that comes to the attention of a medical staff committee once in a blue moon.  
          A targeted doctor who made multiple recurrent errors would fight a rear-guard battle that went on for years to keep his or her practice and income.

Errors in surgery are individual, not systemic

          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.

The avoidance of missed diagnoses

The last time I posted I wrote about the frequency and danger of diagnostic errors. How do we make them less frequent? The information on how to do that is sparse and definitive solutions are lacking. However, several groups of doctors are involved in active quests for answers. To see what they are up against,  let us look at how doctors first learn to make diagnoses.

After gorging their brains with anatomy, physiology, pathology and biochemistry for months on end, medical students are finally allowed onto a hospital ward to examine their very first patient.

Diagnostic errors: the problem

A new study from Johns Hopkins appears this week in the British Medical Journal that shows that diagnostic errors are the number 1 cause of malpractice lawsuits and the number one cause of payouts to patients and their lawyers. What it does not say in the text, but it states in the tables, is that bad surgical results are not far behind. The percentages for payouts for diagnostic and surgical mishaps are 29 and 24%, respectively.  The investigators who wrote the study used a long standing American repository of doctors' misadventures, the National Practitioner Data Bank which contains information on U.

How many bad doctors are there?

How many bad doctors are there among us? How many have a proven record of hurting many patients more than the average physician? This is my area of interest. I was a strict chief of staff of two hospitals over a five year period and looked upon my mission as protecting patients. If you reform or remove doctors who are identified as being dangerous to the public, overall health care should improve because 61% of all harms to patients in hospitals are attributable to the errors, diagnostic and therapeutic, of individual physicians.

Who’s Protecting the Patient?


Public access to the National Practitioner Data Bank was blocked by the Department of Health and Human Services during the past month. A doctor listed therein for having been sued successfully by several patients complained that a newspaper in his area had published that he had also been disciplined by one of the hospitals where he practiced. Alan Bavley, a reporter for the Kansas City Star, had done some detective work with encoded information in the data bank, found the hospital disciplinary measure and by publishing it crossed a line drawn by HHS.

A Man for Patient Safety

            Frightening headlines about the high incidence of harmful medical errors in hospitals have screamed from the front pages of America’s newspapers for twenty-five years, claiming that an estimated 100,000 die annually. In response, the medical profession has relied on the systems approach, which emphasizes the repair of flawed delivery systems as opposed to punishing defective caregivers. I learned as a hospital chief of staff for five years that the blame and punish method is much harder to carry out than the systems method.



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Patient Safety Must Be Carefully Rethought
A New Hope for Reducing Medical Errors
Are Our Hospitals Getting Safer?
Lack of Insight
Errors in surgery are individual, not systemic

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