Checking Up on Medical Mistakes
Study Finds Doctors, Members of Public Diverge
on Causes
By David Brown
Washington Post Staff Writer
Thursday, December 12, 2002; Page A06
About 7 percent of physicians and 10 percent of the general public say
that someone in their family has died as the result of preventable errors in
their medical care, according to a new survey.
A higher fraction of each group -- 12 percent of doctors and 17 percent
of the public -- reported that they or a relative had suffered a medical
error serious enough to cause them to lose time from school or work.
In all, 35 percent of physicians and 42 percent of the public said they
had experienced a medical error themselves, or had one affect a family
member. Eighteen percent of physicians and 24 percent of the public said the
errors had serious consequences.
The study, published today in the New England Journal of Medicine, is the
first effort to quantify the public's experience with medical mistakes as
well as its opinions about how to prevent them. It was conducted by
researchers at the Harvard School of Public Health and the Henry J. Kaiser
Family Foundation.
The problem of medical mistakes burst into public consciousness two years
ago when a report by the Institute of Medicine of the National Academy of
Sciences estimated that at least 44,000 Americans -- and possibly as many as
98,000 -- die as a result each year. Since then, those numbers, and what
constitutes a "preventable error," have been the subject of intense debate.
"Go ahead and cut these numbers by any amount. You are still left with the
impression that these experiences are occurring to a large number of
people," said Mollyann Brodie, director of public opinion research for the
Kaiser foundation and one of the study's authors.
Drew Altman, president of the foundation, said, "I see this as
significant corroborating evidence" for the Institute of Medicine estimates.
"I assume that physicians are more likely to know a medical error when they
see one."
Although the survey found a high rate of perceived substandard care,
neither doctors nor the public ranked medical error among the top four
problems facing medicine. The cost of care and drugs, the cost of
malpractice coverage, the influence of insurance companies and the large
number of uninsured people all ranked higher.
Neither group viewed improving hospital policies and equipment -- as
opposed to weeding out bad practitioners -- as the best strategy for
reducing errors. Experts believe many, if not most, errors could be
prevented through systematic policies or technical innovations designed to
catch errors before harm occurs.
In the study, about 1,300 randomly chosen American doctors were sent a
written survey, and about 60 percent responded. About 1,800 members of the
public were surveyed by phone, with about 70 percent responding.
In a list of more than 10 possible causes of error, a majority of doctors
listed only two as "very important": shortages of nurses; and overwork,
stress and fatigue among health care workers. The public listed those and
five others factors as very important. The most commonly cited factor --
mentioned by 72 percent -- was "insufficient time spent by doctors with
patients."
Only 23 percent of doctors viewed computer programs for ordering drugs
and tests in hospitals as a "very effective" way of reducing errors. Such
systems have been shown to reduce medication errors in hospitals by more
than 80 percent.
"It's absolutely staggering to me" that so few recognize the value of a
systems approach to preventing errors, said Robert J. Blendon, the Harvard
researcher who led the study. "At Harvard, it is like giving water to people
who are thirsty: Everyone agrees it works."
Only one-third of doctors, but three-quarters of the public, believed
that allowing only specialists trained in intensive care medicine to work in
intensive care units was very effective. One researcher has estimated that
50,000 lives could be saved annually if every metropolitan hospital adopted
this policy.
About 40 percent of both groups believed that restricting high-risk
procedures to hospitals that do them frequently will reduce errors. About
one-quarter of the public believes errors are more likely at high-volume
facilities. Restricting high-risk procedures has also been shown repeatedly
to improve outcomes; one study estimated that 4,000 lives could be saved
each year if such a strategy were applied to 10 common surgical procedures.
"The national agenda [for error reduction] involves as its centerpiece
the idea of talking about systems error, not personal error. Both the public
and, to a lesser extent, the physicians don't appear to have bought into
that paradigm yet," said Timothy P. Hofer, a researcher on medical error at
the Veterans Affairs Ann Arbor Healthcare System, in Michigan.
One of the more striking examples of divergence between doctors and the
public involved the reporting of errors. About 70 percent of the public, but
only about 25 percent of doctors, said all serious errors should be reported
to a state agency.
© 2002 The Washington Post Company
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