Medical Errors Report Hits Like 'Nuclear Explosion'
"I think the reason the public has responded as it has [to the IOM report is] because people have in their personal experiences, especially in the health professions, [an awareness that] this is going on, and it rings true," says William Richardson, PhD, chairman of the report committee. Richardson is the former president of Johns Hopkins Medical Institutions in Baltimore.
Still, the report is quick to point out that the problem is not substandard medical care in America, but rather that mistakes haven't been viewed in a systematic way, like they have in the fields of aviation and industry. "The kind of mistakes that we're talking about are the kind that occur not because anybody starts out that day saying, 'Let me see how many patients I can screw up today.' ... These occur because of problems in the design of how we give care," says Bristow.
While pilots can report near misses with impunity, and that information often leads to safety-enhancing changes, the report says no such system exists in health care. Instead of an atmosphere of openness, there is a culture of silence. The atmosphere makes it difficult even to come up with ways to avoid misusing similar-looking medications.
"It would have been very difficult [admitting error]," Molly Coye, MD, tells WebMD of her days in training. Coye, a former director of the California Department of Health and another one of the report's authors, says that doctors learn early that near misses are best kept to oneself. Even if they want to be forthcoming, it's "quite dangerous," says Coye, because of the likelihood of a malpractice suit. For that very reason, AMA immediate past president Nancy Dickey says that doctors need protection before confessing mishaps.
While changing the medical liability system to protect those who acknowledge error is a key recommendation, it doesn't mean protecting incompetence. "The bums and the bad apples we want out just as much as everybody else ... so that a patient doesn't end up having the wrong place on the body operated on," says Bristow.
If nothing else, the IOM report is bound to reopen the debate about how to compensate victims for serious medical error. "I don't think trial lawyers are necessarily the problem, but they're not the solution either," says Larry Gosten, JD, of the Georgetown/Johns Hopkins Program on Law and Public Health. He tells WebMD that good doctors often get sued while bad doctors avoid legal scrutiny, so litigation doesn't necessarily improve quality.
"Punitive damages might prevent certain harmful behavior, but it also might prevent you from innovating. ... It also might encourage defensive medicine," says Gosten, who isn't optimistic that politicians will get the message that legal reforms to encourage adverse event reporting are necessary.