- Agency for Health Care Quality, US Department of Health and Human Services
Well, I politely and respectfully disagree. Medical errors, most of them, are NOT prevented and they can't be prevented.
There, I said it. While none of us wants to be the recipient of a medical error, medical errors might just be good for you.
Now before you call the Illinois Department of Regulation and ask that my medical license be revoked, hear me out.
Most of us have heard ad nauseum "that as many as 44,000 to 98,000 people die in hospitals each year as the result of medical errors." It came from an authoritative and trusted source: the Institute of Medicine's November 1999 report entitled "To Err Is Human: Building A Safer Health System." Clearly, there is a political motive to reduce these errors and certainly, if even one death can be prevented, that is a good thing.
But the Institute of Medicine never examined the number of errors ultimately prevented by institutions reviewing the circumstances that surrounded each of these deaths. Medicine, after all, will never be "perfect" in preserving the sanctity of life since life is never limitless. Unfortunately, medicine has been so erroneously marketed as infallible and full of limitless potential to preserve life, that the media, including our own authoritative WebMD, feel that medical errors are "now a 'leading cause' of death and disability."
But medical errors serve as an invaluable resource and irreplaceable learning tool for our housestaff, physician attendings and nurses. For instance, most medical school and hospital medical and surgical programs are required to have "Morbidity and Mortality" conferences as part of their ongoing training curricula. Here, surgical mistakes and deaths are reviewed critically by scores of those involved in a patient's care. To avoid total humiliation, the responsible doctor usually reviews the literature about the problem that occurred and summarizes the case and its relevancy to that literature. Often the doctor is coarsely questioned by his colleagues, often to his embarrassment to be sure, but also to the benefit of scores of other physicians watching and listening to the conference. The beneficial amplification factor of a single medical error, in this instance, in terms of training and ultimately avoiding further errors, might be 100 to 1. In other words, in the ideal setting, 100 future errors might be prevented because the one error was reviewed critically with 100 other people.
Autopsies are another valuable and irrevocable teaching aide, but sadly, are rarely performed any more. A myriad of questions arise in the course of a complicated and challenging illness - particularly when maladies befall an individual after a single medical error. The opportunity to understand the cause of illness or consequences of our actions proves invaluable to score of others involved in a single patient's fatal medical error. Without reviewing, without examining critically or foibles as human beings, we will never improve our "practice" of medicine.
I look back at errors I have made in the past and how they have influenced the way I perform procedures. In my early electrophysiology career, I would always perform a subclavian approach (in the upper chest) or internal jugular approach (in the neck) for placing an electrophysiology wire into the coronary sinus (the main cardiac vein that returns blood from the heart to the right atrium). Anatomically, I felt in the past, it was easier to gain access to the coronary sinus from these superior approaches. And that was how I was taught. But long ago, I had a pneumothorax, a punctured lung, from trying to gain access to the subclavian vein. I had explained to the patient beforehand that this might happen, but I still felt horrible that the "error" had occurred. I lost countless hours of sleep worried that the patient would not recover. (They ultimately did fine). But what did I learn? I learned that I better check the x-ray after such a procedure. I learned that if there was another way to avoid this complication, I would like to learn it. I later learned how to place coronary sinus catheters from the leg while observing others in a different clinical setting. As such, I have never had a pneumothorax from a routine electrophysiology since and no longer require chest x-rays following these procedures as a result.
Was this error useful? Absolutely. I would even say it was critical to shaping my clinical approach for hundreds of other patients. Errors, as difficult and as unfortunate as they may be, remain critical to our development as doctors. Although no one wants them to occur, they do have benefits to developing a mature perspective and technique to medical practice. Critical review of inevitable medical errors should remain a critical part of our medical school curricula.
After all, how will we really learn?
What I tell my medical students, residents, and fellows is this: it's okay to have a medical error once, just never make the same error twice.
I can live with that.