The way we, as patients, view our medical providers has always been a source of amazement to me. If someone walks into a lawyer’s office with a serious tax problem and the lawyer says that he considers the problem serious enough to require several days of research by a team of attorneys in consultation with specialists in the field, the client walks out thinking “What a clever and careful attorney I have.” On the other hand, the same client when put in the situation of being a medical patient, who after being examined by his doctor, if told by the physician “Your problem is serious. I want to make sure that I come to the right diagnosis so I will spend some time researching the problem and consult with others” is apt to think “What a terrible doctor. Why doesn’t he know what is wrong with me?”
We have created a myth in our society that doctors are infallible, that they don’t make errors, don’t have to look things up, and have a compendium of knowledge that incorporates every disease, every treatment, and every consequence of treatment in their field and know it all by heart! Nothing, of course, could be further from the truth. Doctors do make mistakes, do forget, and don’t know everything. How did the myth of infallibility have its inception? I believe it has been fostered by doctors themselves. Doctors are taught from their first day in medical school that they are supposed to be infallible and when they do not live up to this impossible goal they are so embarrassed and are shamed that errors are rarely reported and, therefore, even more rarely corrected. I am not the first one to come to this conclusion. An excellent article was published in the Journal of the American Medical Association entitled Error in Medicine by Dr. Lucian L. Leape. Dr. Leape is a Harvard Medical Professor in the Department of Health Policy and Management of the Harvard School of Public Health. The article is a reasoned approach to what causes errors in medicine and what can be done to reduce them. When the article was published in December of 1994 it gained little notice except for the notoriety which it produced by reporting about the 180,000 people who die each year as the result of doctor-induced injury and that that is the equivalent of three jumbo-jet crashes every two days. That statistic and characterization have been often quoted. The important part of the article is about what causes medical errors and what, if anything, is being done to prevent them. Dr. Leape’s hypothesis is that the infallibility myth fostered by medical training results in fear, guilt, anger, embarrassment, and humiliation when an error occurs. As a consequence, errors are rarely reported. When an error comes to light, usually because a serious injury has occurred, hospital and physician groups fail to correct the problem and instead punish or eliminate the perpetrator of the error rather than reviewing the underlying causes. When a resident cuts off the wrong appendage, the resident is disciplined, retrained, or drummed out of the program rather than analyzing why we have residents work for 36 hours in a row without sleep so they are prone to make those kinds of errors.
Most errors in medicine deal with medication errors. Yet the same safeguards exist with respect to the dispensing of medicine that has been in place since the time of Hippocrates. The ultimate end-user, in the form of a single nurse, is given the responsibility of making sure that the right medication in the right dosage goes to the right patient, hundreds if not thousands of times every day. There is no planned redundancy. A simple bar code mechanism could dispense the medications quicker and probably more economically with far fewer errors. Medicine is so steeped in tradition that it is as if it cannot get out of its own way to come up with imaginative solutions to problems such as these.
Comparing the error rate in medicine to that of almost any other industry where human life is at stake leaves medicine far back in the pack. If medical statistics are to be believed, somewhere between 1% and 20% of patients admitted to hospitals suffer a serious injury at the hands of a doctor or a nurse. If that statistic applied to the airline industry, no one would ever get on a flight. It isn’t that pilots are any smarter than doctors or that their job is any less complex, it is just that systems have been analyzed in the aviation industry on an institutional basis to prevent disasters. Every aviation accident is investigated by the National Transportation and Safety Board. Pilots are encouraged to report mistakes through a system of Aviation Safety Reporting which is both confidential and free of punishment. Pilots recognize that they are fallible and as a consequence have to follow routine checklists with the backup of a co-pilot. Airplanes are designed with multiple redundant systems. It is expected and anticipated that pilots will make errors. In fact, studies show that errors are made routinely on every flight. A system is in effect to absorb and respond to those errors instantaneously. Lights go off, horns sound, air traffic controllers correct the problem, co-pilots point out the mistake followed by a simple thank you on behalf of the pilot and a routine continuation of the flight without fear of punishment or social ostracism. Aviation recognizes that everyone makes mistakes and has built-in mechanisms necessary to anticipate them and correct them before harm is done. While pilots cannot start an aircraft or even shut it off without a complicated written checklist that has to be followed the same way every time, the most complex of brain or heart surgeries take place every day without a written protocol. Manufacturers of aircraft publish pilot operating handbooks which must be rigidly followed by every pilot who flies that make and model of aircraft regardless of whether it’s in Florida, Kentucky, or Timbuktu. Yet the same operation is performed dozens of different ways in different sequences even in the same hospital by different doctors and even by the same doctor at different times. It is as if we do not dare to question our physicians for fear of disrupting the myth of infallibility. Everyone thinks that their doctor is error-free. Only other people’s doctors make the kind of mistakes that end up in lawsuits. The reality is that all doctors make mistakes and by holding physicians to an impossible standard, which they themselves not only tolerate but insist upon, the system never changes and the same mistakes are made over and over again at different places at different times. Because they occur routinely at 5,000 hospitals across the country, they do not make the newspapers and there is no public outcry for reform as occurs when 300 people die at once when 747 crashes.
It is way past the time for all of us, including our medical providers, to realize that, the myth of infallibility is just that, a myth. People make mistakes, and doctors are people. If someone is injured or killed as a result, their family is entitled to be compensated. In addition, analysis ought to take place as to what caused the mistake in the first place. System errors ought to be corrected if they exist, and systems ought to be designed in advance to accept the inevitability of error, plan for it and, if possible, avoid its occurrence.