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