Patient safety is high on the agenda both nationally and internationally.
Unfortunately, errors will occur. We can minimise this by training, the use of checklists and having a good supportive team structure. What is key is if we do make mistakes we are honest enough to admit to it and not to compound the error.
Incompetence is really a term used to assign blame, fortunately most errors are not due to surgeons who either lack the necessary ability or insight to prevent an error. But we all make mistakes, the key thing is how we react to these errors and aim to correct them or at least don't make things worse.
Yes...!!!!! Im agree that Prevention is better than treatment but in critical condition Every failure is not incompetence among Physicians, there's an alternative course of action. they just have to find it. When they come to a roadblock, take a detour , just to believe in themself and to follow the precisely developed plan & Execute it diplomatically to achive the target while treating patient...there will be mamoth sucess....GOod lk.
I think that´s in fact a three-parter: number one: each occurence of failure has to be looked upon individually, so no general ascription to competence/incompetance can be made. secondly: it is as much a question of how do deal with it, once the failure has taken place. In fact, this is were most shortcommings lie regarding this subject. Lastly, a better safety culture can ALWAYS help to minimize failure. However, it includes first and foremost what has been adressed under my second point...
Researchers from the UK have examined young British physicians' attitudes to and knowledge of patient safety:
Durani P, Dias J, Singh HP, Taub N. Junior doctors and patient safety: evaluating knowledge, attitudes and perception of safety climate. BMJ Qual Saf 2013; 22: 65-71. qualitysafety.bmj.com/content/22/1/65.long
Lemer C, Moss F. Patient safety and junior doctors: are we missing the obvious? (Editorial) BMJ Qual Saf 2013; 22: 8-10. qualitysafety.bmj.com/content/22/1/8.long
About three-quarters of the physicians (74%) who responded to the questionnaire in the study by Durani et al. (2013) agreed that the number of hours physicians work increases the likelihood of mistakes. At the same time, the most experienced physicians and physicians in surgical specialties increasingly agreed that medical errors are a sign of incompetence than graduates and physicians in medical specialties.
Indeed it can be both however safety culture will positively reduce but then incompetance cannot be reduced however adverse events can be reduced but we need to think differently to deal with this
Now a days or rather when Economics is dominating Medici cal profession, it is not only incompetence but lack of sensitivity towards the patient , his sickness and agony
along with self pride is responsible for number all these 'Man made Errors'
To me ' Safety , sensitivity and Sympathetic out look' should be 'high on Agenda'
while treating patients
Dr. Vasant Bele
Medical/medication errors are errors, it should be managed in a better way to prevent the secondary complications. Many interventions has been made to prevent these errors, and showed a good study results. There are tecniques for better management of these errors.
BBC2 HORIZON documentary last night in UK addressed exactly this- it's worth accessing on BBC iPlayer if you can
Dr. Vasant Bele explained very well, incompetence and negligence are the main causes which should be dealt with. Further, the reporting and publishing of Medical and Medication errors is also a lacking problem in many countries.
Doctors, nurses, and other health professionals are all human beings, which means that we aren't perfect, and we sometimes make mistakes. This has nothing to do with competence or lack thereof, it is simply an inevitable part of being human. So the goal of any patient safety initiative should not be to attempt to compel all doctors to be perfect all the time (since that is impossible) but rather to create systems of medical care that support high quality care and make it easy to catch mistakes before they affect patients. For example, pre-printed order sets can be used to remind physicians of evidence-based interventions for particular conditions. Pharmacists can review patients' medication lists and notify the prescribing physician of any interactions. A nurse can get a second nurse to double-check a dose of medication before giving it to the patient. If an error occurs, it can be analyzed in a non-judgmental way to identify problems in the system that can be corrected so the same error doesn't happen again. Pointing fingers at individual health care providers and accusing them of incompetence or insensitivity any time an error occurs, only leads to a culture of shame and blame where errors are hidden and denied rather than dealt with in a productive way. It is unhelpful.
The question should be re written like .......
Are medical errors a sign of incompetence among physicians or can it be prevented through change in 'Medical Culture or Attitude' of the medical professionals.
Vasant Bele
I agree with Vasant with the only change 'reduced' instead of 'prevented' any human affair is affected by some errors..
In this case the main responsibility comes to the Pharmacists. Lindsay also given the exact explaination as well.
Errors are unavoidable but can be prevented with proper attention to their work. Issue of over burdened medical professionals can be one of the reason especially in developing country like India.work related stress should be within limits to maintain competency and better services. So it should not be considered as incompetence all the time.
One of the key questions to address with medical errors is whether or not they are one-off errors or systematic errors. One off errors are often next to impossible to prevent and are typically a result of being human. It is the systematic errors that are of importance to patient safety. I am in complete agreement with many of the comments that are so well articulated above. However, I think that we need to always consider that incompetence may pay a role. Assessment and evaluation to determine competence of health professionals plays an important role in quality assurance and patient safety initiatives as well as being paramount in accountability of self regulation of the health professions.
medical errors are unintended, uncomfortable that occur during patient treatment by PCP and in my opinion it indictes about incompetence in PCP because they are preventable
It depends on the error.
It´s not the first time a full team of physicians amputate the healthy leg.
In my opinion that kind of mistakes must put away the full team from practising medicine... forever.
all medical errors are not always a sign of incompetence. Maintaining a high Quality control, it can be reduced.
As a pharmacist, with the amount of responsibility and volume of prescriptions that we have to fill currently, I take a strong view against the comment made by Syed.
In the USA, people have choices concerning what Pharmacy they go to and in some cases the patient goes to a number of pharmacies such as the supermarket based pharmacy when they are shopping or the department store pharmacy when the situation happens. Often as a pharmacist we do not have the complete patient profile nor do we have the medical chart with the latest lab values. The pharmacist can pick out an error in dosage especially if the dose does not fit the patient however, sometimes the pharmacist is not given the complete allergies, hospitalizations and other factor that if known would pick out a doctor's misadventure with a prescription.
I do know that as pharmacy progresses that errors would be picked up by the pharmacy computer system if we go to a universal health system that we carry our medical history on a credit card or flash drive. Healthcare in the USA is probably the most expensive in the world and the quality is questionable at best. Something has to be done about the doctor's since they are the top of the medical care pyramid. When a problem like this happens the doctor and the pharmacist are often legally challenged. However if we carried all of our information on a credit card or jump drive the amount of errors would be dramatically reduced. The insurance companies would see a decrease in the legal cases and we would have a better healthcare system.
When root cause analysis of medical error is done, the two most common issues are provider communication and knowledge. As those in the thread have said previously, everyone makes mistakes. Healthcare profession simulation education is an effective and an important modality to improve both issues. However, it is often a more expensive way to educate healthcare providers. Current research is not only focused on how simulation education can improve patient safety and quality of care but actually be cost effective.
You should read: "Safe Patients, Smart Hospitals" by Provonost. He spends a lot of time discussing the safety culture in hospitals and holding all practitioners accountable, not just the physicians. I think it would shed insight on a lot of your questions.
Surely, human errors can be reduced changing some perspectives and launching new protocols. We performed some research in this field and in the field of trauma surgery. Please see the attached file for further investigation into this endless field of research.
The medical profession is no different than any other profession whether it be devices, pharmaceuticals, manufacturing, packaging etc. The issue is each person no matter who they are must understand the idea of Quality and how it pertains to their activity. Doing things right the first time is of utmost importance in dealing with surgical procedures. Mistakes are made everyday. Certian procedures are left out due to stress or time or unfamiliarity with the process. Every physician/surgeon must understand QUALITY applies to all that they do. This has to be taught in the learning institutions. Every proceudure should be rehearsed mentally prior to its performance. Difficulties should be anticipated and mentally rehearsed as to the aproach. Teaching institutions must instruct the idea of "total understanding" of the situation prior to any action. Then step by step, with the aid of an assistant, double check each action to be sure it is performed properly. "Doing it Right the First Time" is not only a philosophy but it is a basic principle that applies to all things we as individuals do no matter what it is.
In this area, concepts of "error" are always shifting ground as we refine our understandings about where the dangers lie.
These new understandings need then to be turned into protocol. If medical professionals break clear rules and guidelines without due justification, that would then often be classified as negligence and incompetence.
Attitudes (amongst medical professionals) of active interest in research make a huge difference in terms of getting the newest and best understandings into standard practice.
PHARMACISTS AND DOCTORS BY THEIR PROFESSION ARE HELD TO THE HIGHEST STANDARD OF PERFORMING THEIR DUTIES WITHOUT ERROR OR FACE SIGNIFICANT LEGAL SANCTIONS AS WELL AS LOSE THEIR PROFESSIONAL STATUS. IS THIS A REALISTIC AND ATTAINABLE STANDARD.
For years psychologists and other persons who study the human work habits have supported the principle that ERRORS are a part of the Human makeup and cannot be totally removed without developing a different system that relies on a check system and also practices Quality and a total understanding of the adverse events and misadventures that occur within their practice.
I am a pharmacist and the factor with error especially in the pharmacy and medical fields is that We are human and are prone to make errors and that the number one problem and concern that doctors or any practicing professional is to make an error and immediately be prone to civil, professional and other legal proceedings.
The professions protect their own however the pharmacy profession and in particular some of the Boards of pharmacy use QCI as an manner to address these errors.
QCI focuses more on the error factors, does not blame nor place ownership on the person but on the system and is a better way to address the quality aspects of the profession. The requirements are simple in that everybody participates and sometimes the best solutions come from other personnel. A leader is picked who has some knowledge of QCI and how to run the committee. Meeting are held monthly or if needed sooner. The Pharmacy Board requires meetings at least every three months. The errors that the pharmacy made are discussed to creatively create a process and environment that they are not repeated. Nothing said nor discussed at these meetings can be used legally against the pharmacist nor pharmacy.
(UNLESS NOTHING IS DONE FROM THE QCI MEETINGS)
Doctors should have a system like this where they discuss their errors and have more
of a QCI aspect. Too many times the profession protects its own.
The fact that pharmacies have had a over 200% increase in the number of prescriptions filled and doctors have increased workload and are forced to spend as little time with their patients and leave the questions to the nurse practitioner or other
health care provider. QCI would assist in the development of systems and processes that would not only assist to reduce ERROR but add more Quality into the process.
Most medical errors can be traced to process issues in the system. Of course providers have ultimate responsibility to avoid them but they function in a defined system on controls (or lack of controls). A tremendous amount of research exists to support this assertion.
"To err is human" and, in the majority of cases, medical errors are not the
result of individual incompetence or negligence. Most errors are due to a
series of co-incidental deficiencies at multiple levels of healthcare delivery.
Although medical errors are not created by the system per se, research has shown
that about 50% of them can be prevented by system improvement that safeguards
human practice.
To achieve this, a change in attitude is indeed necessary. healthcare
professionals should view adverse events positively as learning opportunities,
be they mishaps or mistakes. This requires open disclosure of errors, to enable
effective root cause analysis, teamwork and determination to fix fundamental system
problems. Such an attitude and a move away from the blame-and-shame culture would improve safety and quality.
The problem in the making of mistakes and errors also lies in the attitudes of the doctors versus the nurses versus the pharmacist. Many times the pharmacist may call the doctor to change a prescription and the doctor may or may not agree on the change for the patients good. This is especially accurate when the doctor are not seeing the whole picture of the patient - Who may have a financial hardship (large insurance copay or other circumstances) I have also had doctors who disagree entirely with my recommendations and says that I have no reason to question their authority. EGO IS A BIG PART OF NOT HAVING A COOPERATIVE HEALTHCARE TEAM. Every healthcare professional should be treat each other with professional respect and every opinion made by another healthcare provider has value.
I remember a fried of mine who had a kidney transplant and was under the care of 5 doctors who developed some heart pains and they thought he had a heart disorder it ended up that three of the doctors prescribe medications that were affecting his heart. Only one drug rather than three would have solved his problem without the unnecessary worry of a heart problem, All medical healthcare professionals should think more in terms of using today's technical wonders can take care of many patients without going to the hospital. For example a portable ultrasound probe can be attached to the I-phone or android phone to get excellent visual scans and with calling the doctor he can get the results he needs without the patient going to the hospital for the scan. I think that the large hospitals or the research hospitals should be centers to develop technology so that they can touch many more patients without having the patient present. This would also make the system more economic and more efficient,
Hospitals should be only used for the extremely ill or to have surgery.
Hi, Thomas. I agree with you that ego is an issue amongst healthcare professionals, if not all professionals. It’s not just doctors v the rest, nurses and hospital departments are not immune from this problem. Team work in healthcare is particularly difficult to “build” as ”teams” are fluid and patient care invariably multi-disciplinary.
On the one hand, power plays are expected in any organization. On the other hand professional interactions should not be hindered by hierarchal concerns. In the case of patient safety, some institutions employ methods from the airline industry (renowned for its strive for safety) to promote assertive communication across professional hierarchies. All staff is trained in communication styles that enables anyone in the team to respectfully raise safety concerns, regardless of their seniority.
Training is one of the system factors that can be improved. At the same time, the recent advocation of clinical leadership may create change agents for the cultural shift mentioned in the original question.
It is both the medical culture is wide so you cannot stop to train
A lot of physicians don't know any pharmacology whatever is the country
I teached pharmaclogy for 40 years in several countries and I was surprised that students,; residents even physicians did not know yhe pharmacology of aspirin or paracetamol they knew the use of
Read Mary Sue Bogner: Human error in Medicine, and all is there.We are human and commit errors permanently, the question is to reduce them as much as possible, detect them when they are made and correct them immediately.Sounds very simple, but it is not, we have to have awareness of our errors.
The problem with the errors is that they are too many and also we are talking of human lives that are affected. Why do we not have a system in place to have checks
for all processes in place. For example, In the non institutional setting years ago we had a system of one doctor and one pharmacy and so the check of the prescription and the doctors orders was checked.
Now we have the convenience of going to many pharmacies which do not interlink our data together and also many specialists that also do not interlink our medical data together. A few years ago it was thought that we could have all of our medical data onto a computerized card where we could carry our medical information to all of our medical caregivers. This would be an excellent idea and save many so called misadventures both pharmacological and medical.
In the sciences there has been an explosion of information in genetic, biomarker, proteinomics and other sciences that have given more information about where to attack and maybe cure diseases on a cellular level.
Why can't we also work on taking care of the patient without errors. I often wonder with this world of computers and the information era that we need to rethink the health system and use our technologies for the good of the patient.
It would be great to have all professions cooperating together as a team.
I graduated from Pharmacy School in 1976 where I participated in a project where a team of professionals worked together with an equal voice for our professions including medical residents, pharmacy seniors, nursing seniors,podiatrist residents, nutrition and other fields however we worked as a team and the results said that the team approach was a great advance that should be practiced.
Its now many years later and the same idea surfaces patient care teams.
How can we reduce the errors made in this system?
By checks and balances and making sure that everybody in the system is committed and involved in caring for the patient. Too much emphasis is on the payment by the insurance. Doctors, Nurses,Pharmacists and all other health professions have to look at why they went into healthcare- TO help people and care for their illnesses not for the monetary aspects of the profession.
In my opinion, the change in medical culture or attitudes of the medical professionals should begin during the course of studies. The problem is how to include topics related to patient`s safety within the curriculum, taking into account that not all the curricula are equivalent: it is probably easier in the universities with structured curriculum than in those with problem based learning. Much more complicated is the assesment.
Part of the contents could be included as lectures, reduced discussion groups, positive values in Ethics, comunication skills in order to teach disclosure of errors, meetings for discussion of morbidity and mortality. But what is more important during clerkships is the role modelling. Good physicians acting as teachers in wards, operating theatres and in every other site of the medical center show their attitudes behaviours and also reporting of possible errors. These represent examples to be imitated by the students.
Nevertheless, I think that teaching values does not guarantee that the student will incorporate those values to their medical practice after graduation. The equivalence is that you can teach theology but not faith.
Hi, thomas . You have raised many good points for discussion here. You are absolutely right in saying that medical errors can only be reduced if everyone in the system is committed to making it safer; and this requires respect and co-operation amongst healthcare professionals.
Undoubtedly, the safety level of healthcare has much room for improvement. Where my view differs from yours is in how to be safe. Having checks for all processes is intuitively the answer. Is this the ultimate solution? The explosion in technological advance in healthcare and distant communication in large organizations that you have mentioned translates to an exponential number of processes that we have to deal with. Although double checking is essential in critical areas, it’s impossible to do it for all processes as the resources required (manpower, time, costs) would be overwhelming. Achieving a balance is important but difficult to do.
Even if we can cross-check on everything, errors can still occur. For example, the system of double checking for prescription/dispensing has been in place for a long time. Yet such errors still exist, involving doctors, pharmacist and nurses alike. Similarly, the “safer” airline and nuclear industries that we benchmarked against have disasters too. We can reduce errors but we are unlikely to eliminate it.
I’m not suggesting that we can hide behind the cloak of “to err is human” and I’m much reassured that research has shown little correlation between errors and negligence. Apart from a balanced risk management approach, we can make use of errors to improve safety by positively making use of mistakes as learning points to improve safety. This does require commitment and respect as you pointed out.
Hello to all- the discussion has been enlightening the many views on this subject however I must say that this subject has many facets to it. If you go the route of more education and the example of others is good however the flaws are where most of the professions that are mentioned have no room in the course load for additional work on profession values, ethics and changing the system from one that self monitors errors by its own professional organizations to one that looks at the errors and measure them in the quality process manner.
The pharmacy profession has the most required coursework of any profession but do we use even 20% of our knowledge or training NO. That's because of the many areas that pharmacy is practiced we have many different pharmacist specialists and the profession does not have a unified body to push on critical issues.The upgrade a decade ago to a Pharm D or doctorate degree for the profession did not add to the respectability of the profession even with the cost effectiveness and enhanced patient care shown in providing clinical pharmacy services. (plus the additional year of school in clinical areas). The costs of educations make the debts of new graduates incredible and so most of the new graduates are going for where they make more money in the retail areas (65% last year) and use less of the clinical aspects of their education, The hospital setting now has residencies where pharmacists are centered in a hospital pharmacy and are provided education through experience in all aspects of the pharmacy clinical services. They have 1 year and 2 year residencies and currently have become the minimum requirement to work in the hospital.
They reasons why I place the aspects of the pharmacist in this discussion is because we are the monitors of the doctors medical orders and prescriptions and most of the misadventures of medical error is associated with drugs.
We deal with the doctors,question them and their orders and have to perform what they decide or refuse the prescription.We also deal with the insurance company and work hard for the patient's rights for the best care.
Doctors are graded in their performance in how their peers would perform .
The one in a million chance for a drug interaction or patient adverse reaction may occur however, the legal profession does not accept the defense of a medical error
due to human error is present in every profession. The importance of this discussions is that the medical professions affects persons lives and thus has a legal, professional and civil liability,
Unless radical changes can be done in our health care system that make all professions a part of a team for patient centered care and avocation of patient rights the system of care in both institutional and public settings may not improve.
I firmly believe that some amount of errors is unavoidable and that the medical collective should stop to stigmatized medical errors because doing so is the first step towards a collective discussion of medical errors that would permit to avoid them in the future by many others.
Yes very true but correctable errors can be prevented. And I agree training holds the key but it should start right from undergraduate level.Promoting a multidisciplinary approach with sound pharmacology knowledge is otherwise not so easy with todays training patterns.
Maybe new informatic applications could help physicians to avoid many many errors. For example, prescribing drugs that are counterindicated for a particular type of disease could be easly prevented in this way.
I have written much on this subject however I now propose a way to resolve the issues in a cheap and very efficient manner for both the doctor, pharmacist and insurance company,
In todays society we see many doctors, go to many pharmacies and an incomplete picture of the patient is seen by all professionals.
Patient are consumers of healthcare but the professionals that see the patients usually do not have the ability to completely remember every fact of their health care.
Its time that we use technology to apply to our health by having every person have their
medical history recorded on a credit card. This would also allow for the standardization of the medical records system and even stop the endless forms that we see with every visit to a doctor.
MRI and Xrays have been digitized a standard format or a program that looks at formats such as the formats we see with a PDF or even digital film.
Or they can be encoded to prevent personal viewing,
THe advantages to this system would be a complete history of the patient including the needed lab and radiography, MRI and other films. Observations from other doctors. Unify the prescription records to one record base. Standardize the information for the doctor and pharmacy on the Insurance information.
The technology is present today to do this its just factors such as HIPPA, privacy and whom could spearhead this issue, It would be in the insurance companies interest so that appropriate and effective therapy is given, doctors would know better their patients, Pharmacists could not have to key in the personal information and have a complete allergy and drug history, other professionals would know of the patients needs through their history and even if the HIPPA rules could be met would provide a database of conditions, treatments and other evidence related information to make health care work. This would in essence remove the lack of information about a patient. How would it remove some of the errors- by technology- Every pharmacy uses a computerized drug interaction, allergy and drug dosing information,
The insurance companies have a somewhat limited review of the drug data but they too offer dosage information and other requirements of what is covered and the options for the patients. This would effectively remove some of the drug problems.
I do think that technology in the doctor's office would also play a role to prevent
error. Error will never be removed however if the information is present then much of the problems seen in errors will be reduced. The effort to make error a mistake in the system and not penalize a person and efforts of QCI and monitoring of error will become a major part of every health professional and their effectiveness to practice their profession. THis solution would not change the way the healthcare system works nor change the continual struggle for patient care versus insurance care nor the egos of the professions however at some time the hospital and the costs of having hospitals versus today's expanding technologies such as a ultrasound unit can be plugged into a Apple I Phone and the ultrasound given by the patient directed by a doctor, or home sleep studies will become more pervasive as other ways to do thing from home are discovered and are more cost effective not using the hospital.
I do not see the hospital drying but they now are the target for cost reduction and the leveraging of technology at home. Home technology may bring error of another kind however, it has been seen that hospital errors are more prone to mortality or the unnecessary additional hospital stay due to hospital borne infection or other hospital misadventure. How do new doctors learn and the monitoring of their activities especially on those hours in the middle of the night. I remember staying in the hospital with a patient that his last name was my first name and so when the doctor informed me of my kidneys failing- I knew that a serious error had been done besides a HIPPA violation. Error rates should be reported and in the past were swept under the table however now they should be discussed positively and alternatives should be implemented for the betterment of our patients. Hospitals have High risk drugs segregated as well as sound alike drugs- REtail pharmacies should also play be these rules. THe care and health of every patient should be safeguarded.
Medical errors are usually associated with incorrect diagnosis, which leads to wrong medications, doses, and frequency. Other errors are attributable to wrong diagnostic tools, leading to wrong diagnoses and to wrong medications. Failure to cross-check drug-drug interactions is another medication error, perhaps the most common one. Communication is another common one: Physicians are brief in explaining the frequency of dosing, contraindications, and adverse drug events. As a result; most patients, especially low income populations end up taking the medications incorrectly
and inappropriately. Death is not infrequent in the latter category. Failure to be current in one's specialty and in others. As a result, some physicians become incompetent because they are unable to correlate multiple medical conditions. This leads to failure in diagnosis, treatment, and follow-up care. For example, a cardiologist may not know how manage a heart condition and an infectious disease. The same is true for infectious disease physicians who have no clues about cardiology.
Thanks,
Ben
con un entrenamiento sostenido e intensivo y con condiciones optimizadas de trabajo los errores van disminuyendo. habria que llevarlos a un esperado comparable a la aviación comercial. todavía estamos muy lejos de esto.
Senor Ponte,
Su concepto the entrenamiento sostenido e intensivocarece de definicion operational. Como un professional que usted es, quisieramon que usted define los conceptos que haya aportado. Para mi, estos conceptos quizas son contradictorias de la realidad objective dado porque todos los medicos se someten bajo entrenamiento intensivos. Pero, cocmo ser humanos, nosotros nos equivocamoos porques los procesos de trabjao o los protocolos son los culpables para os errors.Estamos de acuerdo?
Muchas gracias,
Ben Olwe
Estamos totalmente de acuerdo pero la optimización de los sistemas de trabajo puede disminuir drasticamente el número de errores en la practica médica. Si cada médico antes de prescribir chequea otras drogas en busca de interacciones contraindicadas, función renal para ajustar la dosis de la droga y patologías de base para evitar efectos adveros prevenibles; si el farmacéutico rechequea estos pasos; si el enfermero tiene tiempo de evaluar que lo que esta dando es lo indicado cada vez que administra, los errores van a ir bajando. Lo mismo a medida que van a pareciendo nuevas drogas ir entrenando al personal profesional de la salud para informar sobre cuando no usar droga (por patolgía, edades, otras drogas).
El errar siempre va a ser una caracteristica humana pero con sistematizaciones se puede llevar a un mínimo los errores.
Gracias por el comentario.
important issues in medical education agend. it shoudd be added to the couses of Medical Ethis. The atmosphere at which medical practice is running is an important factor in medical malpractice
Errors and incompetence are two different issues. While one (error) can be cause by the other (incompetence) you do not have to be incompetent to cause an error. One has to objectively look at the error to find the cause; was the wrong medication given because the vial appeared to be similar to the desired medication, or was the wrong limb operated on because neither one was marked? Once a root cause has been determined, find a solution. A one time error does not signify incompetence, repeated errors may signify reckless behavior that if not addressed will lead to severe consequences.
Everyone makes mistakes, not everyone is incompetent. And if you are honest and forthright with your patient they will be more forgiving than you think.
My point of view, from the Chinese Medicine perspective, is that applying medicine is aimed to make patient healthy. However, our modern life has made one so stressful and imbalance that one has to depend on pills to relieve some common sicknesses such as high blood pressure and diabetes of that sort. I cannot see any incompetence or errors of a doctor because he or she is always learning to do a good job for the patient unless he or she practises medicine unethically. I must say the incompetence and errors fall equally to the patients themselves. I guess we should start with a healthy lifestyle in order to avoid taking medicine from the start. or taking medicine and start a healthy lifestyle. I hope I am not answering your question out of the points.
Medical errors occur for many reasons: "Incompetence", in my view, isn't very useful, in that it is not descriptive of "why" they did not know a particular skill or fact, and failed to detect a problem, make a correct determination of the nature of the problem, or provide the right intervention. Medicine is so complex, and many new findings are generated almost daily, so that in fact, it is nearly impossible for a given doctor to truly "keep up". Most doctors are busy running their own small business, if in private practice, or if they are employed by a health care organization, they are not given much time or allowances to go back and do refresher courses. And the "refresher courses", such as typical CME, are pretty ineffective in increasing doctors' skills and helping them learn and apply new knowledge.
All that said, it is true that some doctors are much better to "keeping up" with the latest scientific findings than other doctors. Because most doctors tend to become eventually 15-20 years out of date with the latest scientific findings, I know of some patients and colleagues who always get a new doctor every 10 years or so, ensuring that their new doctor has recently graduated from a solid, research-based training program.
Unfortunately, errors will occur. We can minimise this by training, the use of checklists and having a good supportive team structure. What is key is if we do make mistakes we are honest enough to admit to it and not to compound the error.
Incompetence is really a term used to assign blame, fortunately most errors are not due to surgeons who either lack the necessary ability or insight to prevent an error. But we all make mistakes, the key thing is how we react to these errors and aim to correct them or at least don't make things worse.
Errors are human. Having said that, I would say that a physician with the wrong attitude is an incompetent one.
Hi, Michiel. Lawyers usually talk about medical negligence and/or "failure to warn" about treatment complications. Fortunately very few medical erros are due to negligence and "failure to warn" doesn't actually affect the occurence of errors.
Certainly, the attitude of open disclosure of errors, taking remedial action and formulating preventive measures are current strategies in patient safety and risk management.
Many contributors have quoted "To err is human", let's not forget the rest of the quote "To forgive is divine". Apart from training healthcare professionals, perhaps the public chould be made aware of fair blame, since medicine is inherently risky, and be educated to work with doctors to make use of errors to reduce errors.
there are many words which have dangerous outfalls on medical science.. medical science is not a static field and everything under the sun could be proved wrong on some lines. One must always have the actual impending conditions in mind when the decision was taken. Like you can label many of the acts of a soldier in ongoing battle as wrong or not what was taught ..but you are not there always and also it would be dangerous to comment anything like this. The world is not 100% efficient no one is no system is, except the superfather or Ishwar or GOD..even the physics tell you the physical efficiency is hardly 30% in most models. So why expect the doctor to be hundred percent complying... take a breath and think over it. We all make errors and we'd always do so. Errors are made by who do not those who just pick!! That's something for the judges, counsels, media and the fools of the likes who think they can say it all . Thanks.
I know that, Mr Anthony and my answer is centered on that only. because there are instances when educated brains give their proof of imbecility. The doctors is usually gentle and courteous everywhere I think in India or US. The efforts of the doctor is the most important service that he can provide. Its much easy to couchcomment and dictate having a book in hand than actually facing the heat and performing in the middle. The overscrutiny and bookish approach to judge a doctor's worth will only take away the art, empathy and humanity out of the doctors work and life.
But there are follies of a thinking mind and that needs correction...
Hi, Michael. I sound like a lawyer because I train doctors in risk management and how to deal with errors in a humane and ethical way. As Anthony Schapera pointed out, society is not tolerant of imperfect outcomes. This is so in most developed countries, especially those that promote consumerism, not just in the US.
Just because things do not always go wrong, it probably means things haven't gone wrong yet; it doesn't mean medicine is not risky. Nor does it always equate to imcompetence when things do go wrong. Nonetheless, patient safety can be improved if doctors develop an attitude towards open disclosure while patients have to be more supportive to the doctors so that everyone (not just the one directly involved) can learn from the error.
When a medical mistake happens to a patient, the question is always why did it happen?
In fact, medical errors usually are the results of many factors and are not only one of negligence by a doctor or other medical practitioner. Causes can be categorized under the following:
1. Inefficient health system
2. Inefficient physician,
3. Inefficient surgeon and/or anaesthetist
4. Inefficient nurse
5. Non-compliant patients
6. Inefficient pharmacist
7. Inefficient laboratory personnel
A blame free medication error reporting system will go a long way in helping to reduce the errors. Also the information will not be in public domain , so the hospital can take action , before the events cause any harm. Of course such an approach would require a never event analysis and there are some logistical difficulties associated it. But with due diligence, this can be done and will prove useful in the long run
A medication error is any preventable event that may cause or lead to inappropriate
medication use or patient harm while the medication is in the control of the health care professional,patient or consumer.(NCCMERP)
Such events may be related to professional practice,health care ,products,procedures,administration,education,monitoring and use.
Important questions to ask :
What happened and why?
What were the contributing factors?
- Age? Hours worked? Staffing?
- Workload? Stress?
- Inadequate equipment?
- Workplace atmosphere conducive to safety?
- Inadequate training of health care giver?
A weakness in a system that dose not immediately result in an error but,
under a right set of circumstances,can contribute to a mistake.
As Anthony Fung truly said, today in most,if not all countries medical errors
are unacceptable.
Sometimes it's not just one reason. Other times it starts when a patient can't understand either because they cant hear or understand. Nothing deserves a pass but it's more about the current human condition of families having little or no time to listen especially in the geriatric patient population. Maybe it's time to rethink the entire reason rather than trying to cherry pick the best excuses. Sharing the messages with the families would be a good start but teaching the family to listen might help as well. It's time to move forward with the best efforts of compassion and communications for the sake of humanity.
Oft repeated, even here, but to err is human. To continue in the same error is foolish. The important thing is to learn from the error.
We may never achieve perfection but we can always be looking for ways to get there.
Medicine unlike engineering is not an exact science, there are many factors that can drive outcomes. The most important is the patient and their family if, as Harper Lee notes in "To Kill a Mockingbird, you must first stand and walk around in ones shoes." We can have outcome based analytics but at the end of the day it is about the patient and whether or not we can change behavior and other aspects of care. If not then we are just like the next guy....
In this occasion, I would like to inform my colleagues that the first Middle East Forum on Quality Improvement in Healthcare started in Doha-Qatar on May, 18, bringing together more than 2,000 local, regional and international experts to discuss quality improvement imperatives and challenges facing the medical profession. It is designed for healthcare professionals working in the Middle East and aimed at any professional who is committed to improving healthcare for the benefit of their patients.
I had worked as a consultant paediatric cardiologist in Hamad General hospital for many years . At that time I have seen two different approches -a malicious approach called 'witch-hunt' aimed to get rid of a doctor and a sysetmic approach to solve the problem and prevent its reccurence. I hope that the latter is now prevailing in Hamad Medical Corporation.
Dear Andrej, significant progress has been made in Hamad Medical Corporation, toward improving health workers quality and service.
I've always tried to appreciate everyone responsibility for the environment we crate and maintain. Yet the more willing we all seem to be to our own core truths the more frustration we find when no one believes in their culpability. Unless we're willing to maintain our probing and questions where would we find our own sense of trust with those so willing to except our blame. maybe it's time to to start asking if MISDIAGNOSIS is a fair answer to give ourselves and our loved ones?
The answer needs to be a collective of converstaions that includes the perspectives I have read and enjoyed. Hopefully a spark of reality can be extended to those willing to use smoke and mirrors and promise us that it will soon be okay.
frankly, I not so sure are you?
Rarely are medical errors a sign of incompetence but if a health professional makes repeated errors that other people do not make then this might be a sign that the individual does not have the necessary skills or knowledge to perform the task or (even less likely) they are deliberately flouting the rules. However, the majority of errors arise from the complex interplay of a range of factors including external and organisational factors (budget setting, recruitment policies, training procedures, procurement decisions), local factors (equipment availability, supervision, team-working and communication) and individual factors (skills, fatigue, stress). For a review of the factors contributing to patient safety incidents in hospitals see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3332004/pdf/qhc-2011-000443.pdf
You can add an element of subjectivity: the attitude towards violations and the feeling that mistakes have never caused disaster in the past. So, continue ...
20 Tips to Help Prevent Medical Errors
Medicines
1. Make sure that all of your doctors know about every medicine you are taking.
This includes prescription and over-the-counter medicines and dietary supplements, such as vitamins and herbs.
2. Bring all of your medicines and supplements to your doctor visits.
"Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date and help you get better quality care.
3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
This can help you to avoid getting a medicine that could harm you.
4. When your doctor writes a prescription for you, make sure you can read it.
If you cannot read your doctor's handwriting, your pharmacist might not be able to either.
5. Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you get them:
o What is the medicine for?
o How am I supposed to take it and for how long?
o What side effects are likely? What do I do if they occur?
o Is this medicine safe to take with other medicines or dietary supplements I am taking?
o What food, drink, or activities should I avoid while taking this medicine?
6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?
7. If you have any questions about the directions on your medicine labels, ask.
Medicine labels can be hard to understand. For example, ask if "four times daily" means taking a dose every 6 hours around the clock or just during regular waking hours.
8. Ask your pharmacist for the best device to measure your liquid medicine.
For example, many people use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people measure the right dose.
9. Ask for written information about the side effects your medicine could cause.
If you know what might happen, you will be better prepared if it does or if something unexpected happens.
Hospital Stays
10. If you are in a hospital, consider asking all health care workers who will touch you whether they have washed their hands.
Handwashing can prevent the spread of infections in hospitals.
11. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will follow at home.
This includes learning about your new medicines, making sure you know when to schedule follow-up appointments, and finding out when you can get back to your regular activities.
It is important to know whether or not you should keep taking the medicines you were taking before your hospital stay. Getting clear instructions may help prevent an unexpected return trip to the hospital.
Surgery
11. If you are having surgery, make sure that you, your doctor, and your surgeon all agree on exactly what will be done.
Having surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. Surgeons are expected to sign their initials directly on the site to be operated on before the surgery.
12. If you have a choice, choose a hospital where many patients have had the procedure or surgery you need.
Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
Other Steps
14. Speak up if you have questions or concerns.
You have a right to question anyone who is involved with your care.
15. Make sure that someone, such as your primary care doctor, coordinates your care.
This is especially important if you have many health problems or are in the hospital.
16. Make sure that all your doctors have your important health information.
Do not assume that everyone has all the information they need.
17. Ask a family member or friend to go to appointments with you.
Even if you do not need help now, you might need it later.
18. Know that "more" is not always better.
It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
19. If you have a test, do not assume that no news is good news.
Ask how and when you will get the results.
20. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.
For example, treatment options based on the latest scientific evidence are available from the Effective Health Care Web site. Ask your doctor if your treatment is based on the latest evidence.
Please visit the following site:
http://www.ahrq.gov/patients-consumers/careplanning/errors/20tips/index.html
Incompetency is defined as lack of knowledge,skills,ability,mental,intellectual or physical capacity to perform a particular job.The root cause analysis of errors are often associated with lack of adequate knowledge,education or training. I perceive quality as a virtue associted with our own conscious and patient safety. Standards of performance,professional practice with Quality as a subject ,incorporated in basic medical education will drive the change. Medical students today lack preparation in quality. Practice often begins in organizational culture that discourages whistle blowing and support for professional development,education and training.The pseudo sense of "All is Well and We are Best" prevails until hulimily for learning for life developes.To err is human but to be proactive for quality compliace and practice altruism is "Godly". Therefore a change in curriculum,conducive organizational culture,and a personal committment to bring about change in attitude towards learning is the only prescription.
The difference between the new and the old physicians - in the old the medical errors happens less and less due the learning curve of the profession and of the life
Medication errors are very common. Some are trivial, some may be fatal for patients. They can be minimised by proper documentation, using generic names for prescription, using capital letters for writing drug names and dosages, checking the dose of medicines before prescribing, avoiding prescribing medicines which you are not aware of, using a P-drug concept, Supervising the medication orders written by residents/junior doctors by senior faculties and having a weekly or bi-weekly audit of case records.
Apart from all said, i think the simplest solution for most of the errors that we nurses come across is having legible prescriptions
I think that medical errors have different aspects. Even the error of 'right' and 'left' might be the consequence of the circumstances you work within. If there is a lot of stress and in the OR the patient is prepared at the time you arrive, you have a high risk of not detecting a wrong side procedure.
On the other hand it is important to achieve the latest knowlegde about the medication, you use in your daily practice, becaus sometimes there a changes in information - especially important warnings, that help you to avert a disaster.
I believe we can reduce medical errors by changing the culture, but some errors we will still have, because they are the consequence of lacking information not provided by your patients ( e.g. allergies)
What the many good points by various contributors show is that there are many things that can go wrong in medicine. Some are under doctors' control, some are not.
All doctors, as well as other healthcare profesionals, can do is to develop a culture of safety and quality. Doctors, in partnerhsip with patients, should always try to reduce risk despite not being to eliminate risk totally.
Identifying the cause of medical areas is essential along with a robust risk management system- research has shown the medical errors can occur for a variety of reasons including systems failure, working outside scope of practice (either as a choice or directed to by a supervisor), poor or lack of communication, lack of appreciation of the severity of a clinical situation, poorly designed teaching and assessment etc- so can one say medical errors are a result of incompetency- one needs to investigate the actual cause/s
Medical error is a big intity , the first step to reduce it by high quality medical education and training followed by clear and applicable guidelines in practice with acontinous monotering and auditing from independent high quality organizations
George Chatzoulis: The pride and egoism of doctors raises medical errors. Consistency, humility and continuing education prevents medical errors.
Medical errors can be reduced by putting the god in your eyes in your work ,good training ,if the error happened you follow it and try to correct not insist on it
As Anthony Fung notes many aspects about healthcare are not under the control of providers but industry; to include payers, employers, and in the US pharma and the retail pharmacy. Of course it is easy to place blame on the person providing the the service to the patient but how about the system ? Health IT can and will change the rate of medical errors when everyone who touches the patient remembers we share something special with them and we use educated and the tools of clinical decision support to make treatment recommendations.
Errors are inevitable in any high-pressure, stressful environment and thus, efforts must be taken to minimise the chance of these occurring. When one looks at medical errors, a useful model to hold in mind is the Swiss cheese model. This is comprised of active failures (e.g incorrect treatment administration) and latent failures (such as lack of nurses on the ward). It is my view that whilst errors may attributable to medical incompetence, they may also be equally attributable to latent conditions that result in a sub-optimal working environment or a combination of the two.
I have been in healthcare for over 24 years and I have always been amazed at the ease of which blame is placed. Please let me share a true story. On a pediatric ward an intern prescribed a medication with a desired dose. Unfortunately the dose was incorrect. the medication was prepared by the Pharmacy then eventually given by the Nurse. Of the three participants the one found to be at fault was the nurse because she gave the medication. Along with all her responsibilities to the patient such as the physical, emotional, and lets not forget the new computer charting, she is asked to correct the error of two prior professionals who have had a great deal more training in pharmacology
In my opinion there seams to be a disconnect in the way medications are prescribed and delivered. There has been a poor utilization of the Pixas system that dispense the medications. Daily weights, age, allergies should all be entered and only through double check system can unusual dose be removed then administered.
It. Has been a very fruitful discussion all medical health providers must realize that the results of their work directly affect a patient. Computerization of systems, more training of doctors and nurse practioners, pharmacists work more slowly and carefully to avoid medication errors. It has been quoted many times that after pts are discharged 50% have serious medical interactions or dosage errors that cause readmissions to the hospital for further treatment. One pharmacy chain. Has taken on this problem headlong and has been criticized by many as crossing the ethical line where they are setting themselves for disallowing fair completion between pharmacies for the discharge prescriptions. Where is the balance and effort to take care of the patient and. Not the business side of the equation. Are we totally blind as to whom the services are for. My proctor for my time taught me a great lesson
Treat the person your treating as if they are a family member-never let anybody criticize you for checking things out with the provider or clarifying the coverage of the insurance. Your a professional and should always treat your clients in a professional manner. I've worked in a few prescription mills whose idea was at least 200rxs a day and so I have lived the life of being well paid but stressed out all the time.
I am lucky in that I have a dual degree a masters in chemistry where I do not work presently work in a pharmacy environment instead. I run a lab however I see the
Real problems of persons who has over 20-30 years since their degree trying to change from other jobs to pharmacy and are having problems with the adjustment.
Pharmacy is in a very difficult but also very opportune time to take some of the problems in the system and make an impact both in improving the quality of care and also provide a direct savings to the healthcare system if allowed. Doctors need to beware that they need help. Nurses and other healthcare professionals need to let the persons most trained in drugs use their talents and abilities and finally the insurance companies needs to make an effort to see and reimburse the pharmacist for his services with patient care especially with a number of well define therapy management programs that have been identified such as anticoagulant, diabetes and hypertension management. There will be more changese to the pharmacists role since now the dispensing role is no longer reimbursed to make any profit and often the pharmacy dispenses with a loss. The medical community has been saying that the pharmacist should be used more for the assessment of drug therapy however it's been a long time in coming that the pharmacist who was the most accessible and gave his advice for free finally will have a value and a place in the processes of the caring of the patient.
Are medical errors a sign of incompetence among physicians or can it be reduced through change in medical culture or attitude of the medical professionals?
1. The primary answer to your question Anthony is Exhaustion on the part of physicians, nurses and assistants and the failure of medical professionals to listen to the patients.
2. Cross-checkathon at every step of the way to ensure the wrong medication is NOT admitted to the patient.
3. Medical professionals must stop believing they are the only ones who have the best interests of the patient the number one priority.
Frustratingly, the attitude of medical professionals go along according a collection of textbooks and previous patient outcomes thus "strongly" recommend yet another trial drug that's just been developed and approved by the medication authority (but has not yet been approved for trial by humans!!!!!)
Thus, it is an unnecessary visit to the pharmacy if it has to been tested in the lab beyond a few weeks! and yet they are recruiting human patients to "trial" or use as guinea pigs for the first time use.
The profession must listen to and believe patients when they inform the professional of the prior experience with a drug thus DO NOT want to return to it.
The errors I see other doctors make are mostly from not listening or not taking the time to go back and read the key parts of the medical record. Or maybe listening but taking it all strictly at face value and not thinking, and not noticing or not reacting when things just don't quite add up.
I have learned to listen and think...and most of the time I catch it when a patient is minimizing or reporting something in a very skewed manner (well, not always, and not always right away, but still, I have had enough experience to catch most of it!) The errors I see myself make are often from not supervising closely enough everything a resident orders, or the medication history as listed on our forms which is often wrong; it is easy to rely on people or information that you don't realize even needs to be questioned, which could be an agency going out of business, a graduating resident getting a little senioritis or stressed out and getting a little sloppier than they usually are, or new information on an old condition that you thought would never change. Just today, a patient called in advance to make sure they could see a certain specialist, and a colleague thought we had them in our clinic and therefore told them no special arrangements were needed, and that WAS true...up until just a few weeks ago. So I guess you can add communication to the list of root causes or errors. And given a combination of fatigue and paperwork overload, my most common mistake to make now is forgetting to check a check box or to write the right order on the right form.
Incompetent, no, human yes. Imperfect people using imperfect systems, some of which seem designed to trip you up. It can all improve, but uniform perfection in all our activities is only an ideal, not a realistic expectation. "Perfection is our goal, and excellence will be tolerated."
Current dogmas argue that medical errors are inevitable in practice. Modern medical practice requires health professionals of high competency. With the influx of patients and paradigm shift towards patient centred care in many public health facilities and health institutions worldwide, medical professionals are spiked with psychological stress and emotional burnout. These are more prevalent in modern medical practice, as well as in residency training. Studies have found significant correlations between these triadic factors of stress, burnout and medical errors. Indeed, an in-depth approach of possibly amending the Medical Act, which varies between country and regions, should be taken into consideration, and possibly amalgamating a more tolerant and flexible work nature to overcome medical professionals burnout and stress. Stress coping strategies, discussion during pass-over the next working day to understand previous day work challenges and difficulties; thus recording previous mistakes and weaknesses will help to prevent medical errors. As mused Osler, the Father of Modern Medicine, that medicine is a science of uncertainty and an art of probability, possible approach and correct intervention to patients will only be adopted over time with extensive practice and experience; thus reducing medical errors.
To err is human, to blame is also human. Clearly, no surgeon ever 'wants' to commit an error. It is usually an error of omission. Check lists are fine but ''wrong site surgery' is due to a system failure and the surgeon unfortunately gets blamed. In one situation I encountered, an arthroscopy patient was anesthetized and tourniquet applied on the wrong site despite the consent clearly stating otherwise. The consent was fortunately taken by the operating surgeon who immediately realized the error before it was done and was rectified. Checklists and time-outs can certainly decrease the incidence of wrong site surgery
I hope that you won't mind me contributing to this discussion, as someone who has now retired from clinical practice but who continues to teach & write about Safe Consulting?
In answer to the question raised about the relationship between incompetence and medical errors, not all medical errors arise from incompetence, or involve incompetent doctors. Some do, of course, sadly. As has been stated, "to err is human" but we need to distinguish between those errors that arise from the imperfections of humans and those brought about by either having no patient safety systems at all, or imperfect ones. We may not be able to achieve perfection and eliminate errors, so, perhaps, what we should be attempting to do instead is to reduce risk and improve safety, as in any other industry where risk to life and limb is involved? Maybe there needs to be some "Health & Safety" training for our student doctor apprentices, as is required, by law, for apprentices in all other industries? I would like to suggest, if I may, that we need to show our students the importance of placing patient safety at the heart of each and every consultation that they conduct. If students are taught to adopt a safe approach to practice from the outset, they are more likely to adopt this approach to their own practice. We need to teach our students how to practice "Protective Medicine" (which protects both patient and doctor), not defensive medicine (which only defends the latter).
I think that there are some simple concepts that can reduce risk and improve safety, which are easy to teach using simple visual models, such as appreciating that illness is a dynamic process. Medical students learn about patterns of illness that are based upon established disease being present, whereas modern healthcare often involves patients presenting to the doctor during the early stages of illness, when the classical symptoms and signs that are disease-specific have yet to evolve. This is especially the case in Family Medicine. The limitations of a single point in time clinical assessment performed early in an evolving illness need to be highlighted, along with how this situation can be managed safely.
Symptom-based, patient safety focused clinical assessment and consultation skills should be taught, in which simple concepts such as "always exclude the worst, first"; "Big Sick" vs "Little Sick" and developing "medical antennae" can be explained. How to perform a risk assessment during the clinical assessment process can be demonstrated through a combination of symptom and case-based learning methods. Patient safety is a large subject but thus far this has tended to involve introducing it into the area therapeutics, rather than into assessment and diagnosis. Safe Consulting seeks to demonstrate how a safe approach to clinical assessment can reduce risks, errors and tragedies for all concerned.
Patient safety is as important as good communication in a consultation and whilst the latter is now an established and integral part of the undergraduate medical curriculum in the UK, the former has yet to even appear on the radar, I'm afraid. If we are going to reduce errors in clinical assessment, then we must teach students how to perform a "safe" clinical assessment, along with what the limitations of a single point in time clinical assessment are in an evolving disease process, so that patients presenting during the early stages of illness can be managed safely.
Of course, there are always concerns raised about introducing more material into the undergraduate medical curriculum but room was found a decade ago to introduce Communication Skills into the curriculum, in response to a recognised need to do so. Is patient safety training any less of a need? Safe Consulting does not require more material to be added but simply a different approach to what is already being taught. Is the need to teach Safe Consulting any less than the need to teach good communication?
What are we saying about our priorities when 50% of the marks awarded in OSCE's are for demonstrating good communication and 50% for exhibiting clinical knowledge and yet there is not a single question within the marking grid that relates to competence, or safe practice? Is it appropriate to allow someone to pass from being a student to a doctor and to take on the awesome responsibility of this role, on the basis that they can communicate well and have some theoretical knowledge but without having made an assessment of their competency and ability to practice safely? What are we saying about our attitude to patient safety when studies have proved that the most dangerous weekend in the year to be admitted to hospital is when the newly-qualified doctors take to the wards? "To err is, indeed, human" but I think that we have a system problem that is in urgent need of fixing here and I would welcome hearing your thoughts on this, based upon your own experiences, or research, please.
Kahneman's work on hindsight bias is an important contribution to this discussion. Once a negative outcome has occurred, the human mind is predisposed to believe that it was predictable and that an error has occurred. In reality the world is much more unpredictable than we are inclined to believe. Checklists and algorithms set us up to provide consistent care of good quality, which should reduce negative outcomes. High standards of accreditation and maintenance of competence may also help. Labeling those who make a decision that leads to a negative outcome as incompetent is unlikely to be helpful.
Thank you for your comments. Incompetent was the term that was chosen and used in the question that was originally asked, although it is not a term that I would choose to apply to an adverse event, myself, except under the specific circumstances where it has been deemed, after appropriate investigation, that competency was truly an issue. It is also not a term that I would wish to see applied to someone's performance without true justification, especially with regard to clinical decision making. Thank you for pointing me in the direction of Kahneman's work, Lisa, for which I am most grateful and thank you both for your comments on something that has not been discussed thus far. This is my first experience of this forum and it has been helpful already in making me think about these issues. Thank you both.
Medical errors might probably, but not always, sign of incompetence in physicians.
Those errors could be minimize by having standard of operation, such as using checklist. Regular training and periodic refreshment of the skills/knowledge, also team work are all necessary to minimize medical errors as well.
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