Often people refer to “the art of medicine” with a sense of awe, wonder and reverence. Although we believe that our medicine is based on science and has come a long way from voodoo and witch-doctors, we still expect something magical from our doctors, especially in times of sickness and vulnerability. Furthermore, people who become physicians are usually highly intelligent individuals who expect something extraordinary of themselves. And why shouldn’t they? After all, their business is life and death. Nothing could be more important to get right than healthcare.

But the truth is, to be biased and to make mistakes is only human, and doctors are human too. Despite current efforts, our healthcare system is fraught with errors. I believe that in order to eliminate medical errors in healthcare, we must first change the culture of medicine.

First, we must admit to that fact that doctors can and will make mistakes. In an ideal world, mistakes would not bring lawsuits, great shame, and cause individual blame. Instead, we should feel safe enough to recognize and report our mistakes so that the cause of an error can be investigated and learned from.

Secondly, we must recognize that our intellect and memories are fallible. Instead of assuming that we know what is best, we should always try to provide evidence based medicine. Physicians should also take advantage of new technologies which might include automatic updates on important studies, electronic records, reminder systems, registries, and safety checks. Some physicians complain that they are giving up their autonomy and cognitive skills by following protocols and wasting time when overriding automated systems, but these technologies have been proven to reduce errors.

Third, we need to advocate for a better working environment. Although there has been much improvement in recent years with limits on resident working hours, almost every doctor I know is overworked and faces great time pressure when seeing patients. When people have sleep debt or are constantly in a rush, they are bound to make more mistakes. Studies have even shown that people who are sleep deprived do worse on driving tests than people who have had alcoholic beverages. This is unfair to both doctors and patients. The system needs to be reformed to ensure better working hours that includes time for not only adequate rest but also for spending enough time with patients, following up, proper documentation of visits, etc.

Last but not the least, we need to learn to ask for help. Because physicians have limited time and resources, we should prioritize working with a healthcare team that includes nurses, health educators, and nutritionists. At some point, doctors have to delegate responsibilities to others. With good communication, asking for help should ensure better care than trying to take on something unmanageable.

These changes are but a start in the continuous battle to improve the quality of care doctors can provide. However, I believe only with these cultural changes will doctors be able to truly improve the quality of care and eliminate errors.

It is an ironic truth that the worst place to heal is the hospital. Beyond the sleepless schedule and scourge of drug-resistant bacteria, medical errors are threatening patient health. Medical errors - inappropriate drug administration, procedures or care, etc. - were the 3rd leading cause of hospital death in 2000 (Starfield 2000). Iatrogenesis not only contradicts a doctor’s obligation to “do no harm,” but also is condemnable because it can be avoided. Medical errors can be mitigated through: (1) Better use of technology, (2) Promoting accountability, (3) Intelligent design of equipment and facilities, (4) Promoting the well-being of health care providers.

Technology can minimize medical error in two ways - by filling information gaps and by checking human judgments. To the first point, it seems that many deficits in care result from imperfect information about the patient. I see this constantly while shadowing at a Santa Monica nursing home. Patients arrive from the hospital with incomplete, confusing charts, leaving us to inefficiently guess which disease they have and which medications they should take. If more patient files were on-line in a universally accessible, standardized and secure format, there would be a greater ability to deliver appropriate care. Secondly, technology can double-check decisions. For example, passing a prescription through a computer system (which might already have the patient’s weight, age, allergy, and other drug information) could automatically check for drug interactions or accidentally lethal doses. While this happens in some institutions, application at a system-wide level could yield great benefits.

It is also important to promote a “safe,” non-punitive environment for providers so that they are less afraid to come forward and correct/report their error. With the threat of job loss, litigation, or social stigma, many errors probably slip by unaccounted. Even if providers report their errors anonymously, it gives the hospital opportunities to self-evaluate, identify patterns of error, and avoid them in the future.

Improved equipment and facility design can also minimize medical error. In an environment that is foolproof and convenient, less decisions are left to the human (the origin of most errors.) This illustrated in needles that cap themselves or require capping after one use. Well-located hand-washing stations (maybe sanitizer at the base of each patient bed) would promote provider cleanliness and reduce infection. A recent survey of patient reports “problems with medical equipment,” as the third most common error-related concern (Burroughs et al. 2007). Standardized and user-friendly equipment (i.e. perhaps with built-in guidance like the Automated External Defrillators found in public places) may help.

There is the saying that “healthy doctors make healthy patients.” Errors can be reduced through improving the decision-making capabilities of the health care providers themselves. This might mean spacing out schedules or reducing hours to minimize exhausted doctors, nurses, and interns. Continuing employee education and testing specific to their hospital can ensure that providers are up-to-date on local practices and procedures.

With determination and creativity, medical errors can and should be reduced - ultimately allowing for improved patient health, reduced medical costs, and for medicine to stay true to its purpose.

References

Burrough TE et al. Patients’ concerns about medical errors during hospitalization, Jt Comm J Qual Patient Saf. 2007 Jan; 33(1):5-14

Starfield B. Is U.S. Health Really the Best in the World? JAMA 2000 Jul;284(4):483-485