MedicalConspiracies- Medical Error "Well, we did our best. These things happen."

Medical Error



"Well, we did our best. These things happen."

At least 100,000 hospital patients dying each year due to medical

malpractice in the U.S.

"Substandard or negligent care have been swept under the rug" by the

medical profession for too long.



"'The person most likely to kill you is not a relative or a friend, or

a mugger or a burglar or a drunken driver. The person most likely to

kill you is your doctor."

---- Vernon Coleman, author - What Doctors Don't Tell You



It's a wonder any of us makes it out of the doctor's office or

hospital alive



Physicians SHOULD disclose to patients information about procedural or

judgment errors made in the course of care



A 2000 Institute of Medicine report estimated that medical errors are

estimated to result in about between 44,000 and 98,000 preventable

deaths and 1,000,000 excess injuries each year in U.S. hospitals.[



^ Zhang, J., Patel, V.L., & Johnson, T.R (2008). "Medical error: Is

the solution medical or cognitive?". Journal of the American Medical

Informatics Association 6 (Supp1): 75–77. doi:10.1197/jamia.M1232.



A medical error is a preventable adverse effect of care, whether or

not it is evident or harmful to the patient. This might include an

inaccurate or incomplete diagnosis or treatment of a disease, injury,

syndrome, behavior, infection, or other ailment.



The American Medical Association's Council on Ethical and Judicial

Affairs states in its ethics code:



"Situations occasionally occur in which a patient suffers significant

medical complications that may have resulted from the physician's

mistake or judgment. In these situations, the physician is ethically

required to inform the patient of all facts necessary to ensure

understanding of what has occurred. Concern regarding legal liability

which might result following truthful disclosure should not affect the

physician's honesty with a patient."



From the American College of Physicians Ethics Manual[62]:



"In addition, physicians should disclose to patients information about

procedural or judgment errors made in the course of care if such

information is material to the patient's well-being. Errors do not

necessarily constitute improper, negligent, or unethical behavior, but

failure to disclose them may."

However, "there appears to be a gap between physicians' attitudes and

practices regarding error disclosure. Willingness to disclose errors

was associated with higher training level and a variety of patient-

centered attitudes, and it was not lessened by previous exposure to

malpractice litigation".[63] Hospital administrators may share these

concerns.[64]



Consequently, in the United States, many states have enacted laws

excluding expressions of sympathy after accidents as proof of

liability; however, "excluding from admissibility in court proceedings

apologetic expressions of sympathy but not fault-admitting apologies

after accidents"[65]



Disclosure may actually reduce malpractice payments.[66][67]



[edit] Disclosure to non-physicians

In a study of physicians who reported having made a mistake,

disclosing to non-physicians sources of support may reduce stress more

than disclosing to physician colleagues.[68] This may be due to the

physicians in the same study, when presented with a hypothetical

scenario of a mistake made by another colleague, only 32% physicians

would have unconditionally offered support. It is possible that

greater benefit occurs when spouses are physicians.[69]



[edit] Disclosure to other physicians

Discussing mistakes with other doctors is beneficial.[48] However,

doctors may be less forgiving of each other.[69] The reason is not

clear, but one essayist has admonished, "Don't Take Too Much Joy in

the Mistakes of Other Doctors."[70]



[edit] Disclosure to the physician's institution

Disclosure of errors, especially 'near misses' may be able to reduce

subsequent errors in institutions that are capable of reviewing near

misses.[71] However, doctors report that institutions may not be

supportive of the doctor.[48]



[edit] Use of rationalization to cover up medical errors

Based on anecdotal and survey evidence, Banja[72] states that

rationalization (making excuses) is very common amongst the medical

profession in covering up medical errors. Common excuses made are:



"Why disclose the error? The patient was going to die anyway."

"Telling the family about the error will only make them feel worse."

"It was the patient's fault. If he wasn't so (obese, sick, etc.), this

error wouldn't have caused so much harm."

"Well, we did our best. These things happen."

"If we're not totally and absolutely certain the error caused the

harm, we don't have to tell."

[edit] By harm or not harm to patient

A survey of more than 10,000 physicians in the United States came to

the results that, on the question "Are there times when it's

acceptable to cover up or avoid revealing a mistake if that mistake

would not cause harm to the patient?", 19% answered yes, 60% answered

no and 21% answered it depends. On the question "Are there times when

it is acceptable to cover up or avoid revealing a mistake if that

mistake would potentially or likely harm the patient?", 2% answered

yes, 95% answered no and 3% answered it depends.[73]



Legal procedure



Main article: Medical malpractice

Standards and regulations for medical malpractice vary by country and

jurisdiction within countries. Medical professionals may obtain

professional liability insurances to offset the risk and costs of

lawsuits based on medical malpractice.



[edit] Methods to improve safety and reduce error

Further information: Patient safety

Medical care is frequently compared adversely to aviation: while many

of the factors that lead to errors in both fields are similar,

aviation's error management protocols are regarded as much more

effective.[80]



patient's informed consent policy

patient's getting a second opinion from another independent

practitioner with similar qualifications

voluntary reporting of errors (to obtain valid data for cause

analysis)

root cause analysis

Electronic or paper reminders to help patients maintain medication

adherence

systems for ensuring review by experienced or specialist

practitioners[81]

hospital accreditation

[edit] Reporting requirements

In the United States reporting medical errors in hospitals is a

condition of payment by Medicare.[82] An investigation by the Office

of Inspector General, Department of Health and Human Services released

January 6, 2012 found that most errors are not reported and even in

the case of errors that are reported and investigated changes are

seldom made which would prevent them in the furture. The investigation

revealed that there was often lack of knowledge regarding which events

were reportable and recommended that lists of reportable events be

developed. [83]



[edit] Misconceptions of medical error

Common misconceptions about adverse events are the following, and in

parentheses are the arguments and explanations against those

misconceptions:



"Bad apples" or incompetent health care providers are a common cause.

(Although human error is commonly an initiating event, the faulty

process of delivering care invariably permits or compounds the harm,

and is the focus of improvement.[6]

High risk procedures or medical specialties are responsible for most

avoidable adverse events. (Although some mistakes, such as in surgery,

are harder to conceal, errors occur in all levels of care.[6] Even

though complex procedures entail more risk, adverse outcomes are not

usually due to error, but to the severity of the condition being

treated.).[19][84] However, USP has reported that medication errors

during the course of a surgical procedure are three times more likely

to cause harm to a patient than those occurring in other types of

hospital care.[20]

If a patient experiences an adverse event during the process of care,

an error has occurred. (Most medical care entails some level of risk,

and there can be complications or side effects, even unforeseen ones,

from the underlying condition or from the treatment itself.[85]

[edit] See also

Adverse effect

Adverse event

Serious adverse event

Adverse drug reaction

Biosafety

Complication (medicine)

Fatal Care: Survive in the U.S. Health System (book)

Iatrogenesis

Medical malpractice

Medical resident work hours

Negligence

Patient Safety and Quality Improvement Act of 2005

Patient safety and nursing

Patient safety organization

Quality Use of Medicines

Swiss Cheese model of accident causation in human systems

To Err is Human: Building a Safer Health System

References

http://en.wikipedia.org/wiki/Medical_error











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