_____What's Your Opinion?_____   • Share Your Views About Editorials and Opinion Pieces on Our Message Boards • About Message Boards   E-Mail This Article   Printer-Friendly Version   Subscribe to The Post

Monday, December 9, 2002; Page A22

ENRON AND its successor scandals have shown that one should be skeptical of highly qualified professionals -- in those cases, accountants -- who promise to regulate themselves. This skepticism should now be applied to doctors. As The Post's Sandra G. Boodman reported last week, the medical profession is making scandalously slow progress in reducing the rate of medical errors in hospitals -- errors that, according to an Institute of Medicine study three years ago, kill between 44,000 and 98,000 patients annually while injuring perhaps 1 million more.

The sources of error are various. Surgeons mix up patients' X-rays or look at them the wrong way up; as a result, they operate on the wrong patient or the wrong body part. Doctors and health workers fail to follow basic hygiene procedures such as washing hands or changing gloves; the consequent infections account for thousands of deaths a year. The largest single source of error stems from faulty drug prescriptions. One recent study found that one in five doses of medicine dispensed to patients involved an error. Either the wrong drug was given, or the wrong dose, or it was given at the wrong time.

These various errors reflect the arrogance of the medical priesthood. Even though doctors themselves have produced studies showing how fatigue erodes worker competence, they persist in thinking that it's normal for junior members of their profession to put in more than 100 hours of work a week. Even though every other profession has embraced computers' ability to enhance human performance, doctors persist in scribbling prescriptions in illegible handwriting rather than punching them into a computer that might alert them if the dose is wrong. Studies of hospital infections find that junior workers are most likely to wash their hands properly. It is doctors who are most likely to forget this chore.

There are honorable exceptions. The government-run veterans' health system is a pocket of excellence; some private hospitals, such as the Luther Midelfort Hospital in Eau Claire, Wis., have made big strides in safety. But in general the problem does not get much attention. The national system for reporting medical errors is voluntary, so few errors get reported. A few states have mandatory systems, but most still do not.

So long as patients have no way of finding out which hospitals are unreliable, bad hospitals will face minimal incentives to invest in the solutions that could drive error rates down. Computer systems that track medications going to each patient can eliminate dangerous interactions between drugs prescribed by two different doctors; they can screen for possible allergic reactions; they can query odd dosage levels. But such systems are expensive. Somebody must force hospitals to admit to errors, or hospitals won't invest in reducing them.

The obvious somebody is government, which is easily the biggest payer for health care. The Medicare authorities need to insist on proven safety procedures, such as computerized prescription systems, which currently exist in only about 3 percent of hospitals. They should extend their efforts to publish quality reviews of medical providers. Meanwhile state or federal regulators should require the reporting of errors and should make some of this information public. Otherwise thousands will continue to die needlessly and with no one held to account.