Medical Error, the Forgotten Issue عامر التواتي

Medical Error, the Forgotten Issue

Amer Eltwati Ben Irhuma,*

“A year from now you will wish you had started today”    Karen Lamb

Introduction:

Human error is defined as "an inappropriate or undesirable human decision or behavior that reduces, or has the potential for reducing, effectiveness, safety, or system performance".¹

It is also defined as the failure of a planned action to be completed as intended (i.e., error of execution), or the use of a wrong plan to achieve an aim (i.e., error of planning).  

Errors in healthcare have recently been the focus of public attention due to improper media handling. "More people die from medical errors than motor vehicle accidents, breast cancer and AIDS combined".² All humans make errors. Indeed, the ability to make mistakes allows human beings to function.  One of the greatest contributors to accidents in any industry including health care, is human error. However, saying that an accident is due to human error is not the same as assigning blame because most human errors are due to system failures. Humans commit errors for a variety of known and complicated reasons. Current responses to errors tend to focus on the active errors.  Although this may sometimes be appropriate, in many cases it is not an effective way to make systems safer.

Prevalence of Medical Errors:

The problem was highlighted many years ago by Dr. Lucian Leape and most recently in a report from U.S. Institute of Medicine IOM entitled  “To Err is Human”.^3,4  The report places medical errors as cause of between 44,000 and 98,000 annual fatalities in the U.S., which makes it the fourth most common cause of death.

Studies conducted by Harvard researchers in 1991, indicated that 3.7% of hospitalized patients suffer significant iatrogenic injuries, typically from errors or negligence.⁴

Newspaper and television stories of catastrophic injuries occurring at the hands of clinicians spotlight the problem of medical error but provide little insight into its nature or magnitude.⁵

Reeder, describes three types of cultures as they relate to Safety:

“Pathologic cultures” that don’t want to know about issues, they shoot the messengers, avoid responsibility, conceal or punish failure and squelch new ideas;

“Bureaucratic cultures” that may not hear about safety issues, but when they do, the messengers are listened to, quick reflexes are used, and responsibility for improvement is compartmentalized; and

“Generative cultures” seek information about safety, rewards those who report issues, share responsibility and, when systems fail, widespread change is triggered.⁶

Although errors are often attributed to the action of an individual, there are often a set of external forces and preceding events that have led up to the error.

These forces and events are often difficult to anticipate, and yet, the reaction to errors, especially in medicine, is often to punish the individual, rather than examine the error-prone system as whole.

Understanding that medicine today is a culture of complex systems and how the design of those systems contributes to medical errors is critical to making care as safe as possible for a patient.

Our problem:   

The issue of medical error in our society, both medical society and society in general, has been the forgotten issue,  or Taboo  for a long period of time despite the legislation that governs the medical practice which lacks the fundamental understanding of medical error. Moreover the number of lawsuit has increased sharply for the wrong reason aiming at financial compensation for the victim and neglect to make safe practice.

*) Dean, Faculty of Medicine, Sebha University, Sebha, Libya.

It is about time to take the first step on the long run to reduce errors in health care to the same low levels seen in other high-risk enterprises like aviation. Revision of law regarding the medical practice in this country represents the first step to take, however, implementing tough rules to punish the individual is not the only and the right policy to have. If the entire system of the medical care is not addressed openly and honestly, we will continue to lose more lives. Leaders in Libyan health care must recognize the problem and appreciate the need of the whole medical care policy in Libya for comprehensive redesign to catch the concept and practice of modern medicine. In this regard, we hope, perhaps vainly that Sebha Medical Journal would start the positive debate aiming at building safe and effective health care system in Libya.

References:  

1. Institute of Medicine, LISA, “To Err is Human 1", 1990.

2. Institute of Medicine, LISA, “To Err is Human 2", 1991.

3. Institute of Medicine, LISA, “To Err is Human 3", 1992.

4. Leape LL, Lawthers AG, Brennan TA, Johnson WG. Preventing medical injury. QRB Qual Rev Bull 1993; 19: 144-149 [Medline].

5. Cook RI, Woods DD, Miller C. A tale of two stories: contrasting views of patient safety. Chicago, IL: National Patient Safety Foundation, AMA, 1998. 

6. Reeder, JM. “Patient Safety: Cultural Changes, Ethical Imperatives”. Healthcare Papers, 2001; 2(1):48-54.