Medical mistakes are as old as the practice of medicine itself, but it wasn’t until 1999 that the United States started paying more attention to them.
Over 20 years later, we may be reducing medical errors — a recent study published in JAMA found significant decreases in mistakes in cases of pneumonia, acute myocardial infarction, heart failure, and surgery between 2010 and 2019 — but the way we’re reacting to people who disclose them is worrying. That is, we treat those who report them more harshly than those who cover them up.
Recently, the West Los Angeles VA Medical Center reinstated Dr. Robert Cameron as chief of thoracic surgery; Dr. Cameron reported concerns about anesthesia care in two near-death cases he was involved with. Subsequently, the medical center forced him to retire early. That was back in 2018. It took nearly 4 years to restore him to a position he lost because of his honesty.
It brings to mind the highly publicized case of Radonda Vaught. In May, a Tennessee court sentenced Vaught, a former nurse, to 3 years of probation for administering the wrong medication to a patient when she worked at Vanderbilt Medical Center after a jury convicted her of criminally negligent homicide.
To her credit, Vaught did come forward when she realized what had occurred, but Vanderbilt didn’t report the error to the government or medical examiner. Vanderbilt has faced no penalties in the case.
Recently surfaced was the story of a woman who contracted a serious infection from presumed mistakes made by providers at Griffin Hospital in Connecticut; a lawsuit is pending in state court that alleges, among other errors, that standard of care for her condition was not done and proper medical records were not kept. None of the accused providers have lost employment, licenses, or faced criminal charges as of yet.
When it comes to medical errors, it’s not the so-called crime that’s concerning, it’s the cover-up. Transparency is key to preventing future errors and fixing breakdowns in systems.
Medical errors were once said to be the third leading cause of death, but that ranking may not be entirely accurate. That doesn’t mean this isn’t a serious problem. Errors caused over 123,000 deaths between 1990-2016, not necessarily a leading cause of death but still quite significant.
Up to 9,000 annual deaths are reportedly attributed to medication errors alone. In 2021, 1,197 serious patient safety incidents (ones leading to death or significant harm) occurred in the United States, according to The Joint Commission, an independent organization that accredits healthcare organizations and programs in the United States.
But we don’t know all we should about medical errors and when they occur; some may be hidden. In 2016, Medscape surveyed over 7,500 doctors in more than 25 specialties. Regardless of workplace setting, up to 7% of respondents said it was acceptable to not report an error, and 14% stated it depends on circumstances.
This was in contrast to 2010, when only 5% of doctors were willing to not report an error, and in 2014, when 9% of doctors were OK with not divulging.
These numbers don’t necessarily mean that providers are covering up errors. We also don’t have a very precise definition of medical errors, so the lack of reporting may be motivated more by ignorance than a desire to hide the facts.
That lack of definition limits the effectiveness of systems — communication and resolution programs are new ways of reducing errors, hospitals’ safety reporting systems allow staffers to communicate anything that affects patient safety that are in place and are known to work; a recent meta-analysis from 2018 showed a significant reduction in mortality from using the World Health Organization’s surgical safety checklist developed to decrease errors in the operating room.
But we can’t rule out that witnessing what Dr. Cameron and Vaught went through might lead other providers not to report. Vaught herself expressed concern that her conviction would cause other providers to “be wary about coming forward to tell the truth.” Additionally, depending on its outcome, the case in Connecticut may encourage providers not to acknowledge errors at all.
And if providers whitewash more errors, then we won’t be able to improve flawed systems. Keeping patients safe requires healthcare providers to know what to report and have the confidence that superiors won’t punish their candor.
I’ll admit that some guardrails aren’t as perfect as we want them to be. For instance, it’s unclear how automated medication cabinets help reduce errors consistently. Also, these systems’ effectiveness depends on reliable performance by staff; nurses can become frustrated when dealing with imperfect technology and instead override the system to get what they need. Proper use depends on staff training and avoiding workarounds to save time.
Physicians, prosecutors, and administrators should be working on defining medical errors and training providers on how to optimally use the systems in place rather than penalizing and prosecuting whistleblowers and providers who commit errors due to failed systems.
Ultimately, the problem underlying medical errors is the need to assign blame. We reduce these problems to the actions of individual people rather than recognizing them — even inexperienced caregivers and lackluster technology — as systemic problems. That’s what they are. And they’ll only be reduced by systemic — as opposed to individual — solutions.
Vidya Raju, MD, is an internal medicine-pediatrics physician.
This post appeared on KevinMD.