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Doctors say care quality is fine; public isn't so sure

Physicians say they want more training on how to handle errors but don't want the public to have access to error-reporting systems.

By Andis Robeznieks, AMNews staff. Nov. 18, 2002. Additional information

Unlike the general public, physicians don't believe the quality of medical care is a problem or that a national agency to address medical errors is needed, according to a study published in the Oct. 28 Archives of Internal Medicine.

"I think, overall, physicians tend to minimize quality problems -- both at a personal level and an institutional level," said the study's author, Andrew R. Robinson, MD, an internist at Presbyterian/St. Luke's Medical Center in Denver and an assistant professor of medicine at the University of Colorado Health Sciences Center.

The study surveyed 594 physicians in Colorado, 304 physicians from throughout the country and 500 Colorado households.

While 67.6% of the households viewed quality as a problem, only 29.1% of the Colorado physicians surveyed and 34.9% in the national physician sample felt the same way.

Other significant differences included 59.8% of the Colorado households calling for a national agency to address medical errors, compared with only 24.1% of the Colorado physicians; and 90.2% of the public sample calling for mandatory reporting of serious medical errors, compared with only 54.7% of the state's physicians.

"The public thinks physicians should be held accountable for the errors they make, and I can understand that," Dr. Robinson said.

Colorado physicians (69.7%) and the public (86.6%) both strongly believed that reducing medical errors should be a national priority, but Dr. Robinson downplayed that finding.

"It's what they ought to say, so they say it," he said. "But most physicians don't tend to agree with a lot of the solutions proposed -- especially mandatory reporting, because most are concerned about medical malpractice."

In the study, 95.5% of the Colorado doctors surveyed and 98.4% of the national physician sample felt medical malpractice litigation was a barrier to the reporting of medical errors.

There was also agreement among doctors on the need for more training in how to handle errors (92.9% in Colorado, 93.1% nationally).

For the study, an error was defined as an adverse event resulting in death or serious harm, but Dr. Robinson said some people want to include mandatory reporting of "near misses" -- or something that could have potentially resulted in serious harm. Also, he said, there are others who want to differentiate between accidents and errors caused by negligent care.

The study found that only 28.3% of Colorado physicians surveyed and 26.3% of the national physician sample thought the public should have access to error-reporting systems.

"It was dumb that we didn't ask" the public that question, he said. "I don't know if the public would favor mandatory reporting if they didn't have access."

Dr. Robinson said this showed the need for more studies. He and his colleagues may follow up with surveys of public opinion on quality-of-care issues, public attitudes toward doctors, and questions on how information from error-reporting systems should be used or not used.

Dr. Robinson said there also should be an educational effort to let the public and more physicians know that there is an existing national agency addressing patient safety: the Agency for Healthcare Research and Quality, which operates within the U.S. Dept. of Health and Human Services.

"I wonder if most physicians who aren't involved in quality improvement at the hospital level know what AHRQ is and what its role is," Dr. Robinson said. "It might make the public feel a little better knowing AHRQ is in place and its efforts are improving their quality of care."

In addition to easing the public's concerns, he said more public knowledge of the agency could help keep AHRQ safe from budget cuts. The proposed fiscal 2003 federal budget calls for decreasing funding for AHRQ by 16.2% or about $48.7 million less than was budgeted for 2002.

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 ADDITIONAL INFORMATION: 

AHCPR, the Agency for Healthcare Research and Quality (http://www.ahcpr.gov/)

Abstract, "Physician and Public Opinions on Quality of Health Care and the Problem of Medical Errors," Archives of Internal Medicine, Oct. 28 (vol. 162, issue 19) (http://archinte.ama-assn.org/issues/v162n19/abs/ioi10641.html)

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Copyright 2002 American Medical Association. All rights reserved.