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Friday, 24 March, 2000, 16:40 GMT
Medical error - should we know?

The UK's leading health journal says thousands of people die each year as a result of medical error.

The British Medical Journal arrived at the figure after an American study suggested about 100,000 US citizens die each year from preventable hospital mistakes.

The president of the UK's General Medical Council, Sir Donald Irvine, said it was "a complete fallacy" to think that doctors should be expected never to make mistakes.

But should doctors be more open when things go wrong? Would a greater willingness to acknowledge when mistakes are made help create a better health service?

Making a mistake is dangerous but covering up is fatal.

Ebru Yıldız, Turkey
We are all human beings; whether we are a teacher, journalist, lawyer, engineer, manager or a doctor. Human beings are liable to make mistakes. The important point here is the intention. If a person is aware that he's done something wrong, he/she should not cover it up. Making a mistake is dangerous but covering up is fatal.
Ebru Yıldız, Turkey

When a person's livelihood is at stake, the last thing that person wants is full disclosure. Your proposition will mean increased costs through avoiding litigation
Sean Clipperton, Hungary

We currently live in a blame-orientated society where nothing can pass as simply 'human error'

Jenni, UK
I wish I were perfect and never made a mistake. There are few human-orientated occupations on which lives depend, where stress is so great and the profession and its required knowledge changing so radically and fast. We now seem to expect every doctor to know everything and to be able to cure everything, and if he can't, he takes the blame. We currently live in a blame-orientated society where nothing can pass as simply 'human error' - somebody has to be responsible and somebody has to pay. Making doctors declare their mistakes - even those where no harm was done - is simply an open invitation to ambulance-chasing lawyers.
Jenni, UK

Whenever a doctor makes a mistake that is the cause of permanent injury or death the patient and/or family members should be made aware. We do not excuse police when they are in error. To continue to cover up is morally wrong by any standard.
John T Alafonso, USA

"Yes". You have a right to know if a medical mistake was made. Would you expect less from a carpenter that you hired to do a repair on a house or building. Of course, not. Mistakes need to be made known before they can be prevented from happening again.
Dave Adams, USA

A key aspect of medical error reduction is to provide a way for consumers to be involved. The key stakeholders should all be at the planning table when patient safety is discussed.
Steven Shea, United States

For God's sake lets stop harassing doctors, and start demanding what we are entitled to from the government.

I'm surprised and somewhat dismayed by the many of the comments that have been put forward here by US citizens. Firstly, the healthcare systems here and in the US are poles apart, and don't stand comparison. Theirs is mostly private, ours mostly public. this makes for very different sets of legal responsibilities and malpractice standards. But more importantly, the reason many Americans have complained about the 'closed ranks' problem they have experienced is because of the 'if in doubt, sue' mentality that afflicts their legal system, and scares the medical profession into charging higher fees and not admitting liability under any circumstances.

The NHS does not yet face hostility on that scale, but it is getting that way. Do the British public really want to see doctors refusing to treat patients on the grounds that they may be sued if the treatment fails? We must all accept the limits of what our NHS system can do, and also accept that we can't always spot illnesses in time to prevent them. For God's sake lets stop harassing doctors, and start demanding what we are entitled to from the government.

First off, let me say that I am an attorney, and a decent percentage of my practice is investigating medical malpractice claims. Having said that, of course it would be better for the overall community if doctors were more open with mistakes; but the problem is not with the doctors, but with their insurance companies. Insurance companies make billions of dollars and are not quick to pay any patient who has been injured through a mistake. If the insurance conglomerate was more willing to pay what is fair in simple cases of mistake, there would be much less litigation. Additionally, those physicians who are continually negligent in the care they provide (and I believe this is a very low percent) should be "run out" of the practice of medicine; just as careless attorneys.
William Powell, U.S.A.

Doctors in the UK make mistakes because they individually have to see far too many patients at one time to concentrate on individuals. Ward rounds of 40 to 50 emergency admissions in a couple of hours are the norm in the NHS. We make mistakes day in day out because of the system we work in. None of us are going to admit to this because this government are looking for scapegoats to deflect criticism from their gross underfunding of the service and will NEVER correct the problem underlying mistakes. The present mantra in the NHS is "don't put your head above the parapet".
A Physician, Wales

The notion doctors are next to God - must cease. Doctors are just as human as anyone else and are bound to commit mistakes. Unless people accept their mistakes they cannot correct it - so let the errors be made public information. We cannot compare practice of medicine with other professions - others have a chance to correct their mistakes - in medicine that may not be possible for medical errors are paid with precious life. Doctors must stop thinking they are an exclusive club that cannot be challenged and learn to accept mistakes and correct it.
Isaac Pappy, USA

I think it would improve patient confidence if doctors were open about their successes and failures. It would also highlight the superstar-doctors who rarely make errors. However, I can see the headlines in "The Sun" now, "HORROR DOCTORS ADMIT TO 10% OF TREATMENTS BEING WRONG!" Unless the sensationalist gutter press can be coerced into a responsible attitude, doctors will be vilified for the sake of extra circulation.
JI, Scotland

To Dr. Spinks - I and I hope many others in Britain are extremely sympathetic to your situation and that of the medical profession regarding professional errors. The press and to some extent the law in the UK are absolutely brutal in their attitude to medical error, more often than not unfairly. They simply don't account for how much we don't know about the human body and how to treat it.
This is compounded by the intense workload that many of you have to carry, and to cap it all, criticism is often misdirected at the NHS, rather than the government, who still massively underfund our health system compared to most other European countries. Pressure and criticism MUST be redirected at those with the power to improve the situation.

I would think that doctors' mistakes occur everyday. But they won't be known unless doctors recognise them. They won't be regarded unless doctors confess them. I am a neurosurgeon and have seen lots of mistakes. I would think that regard them and confess them is the first step for saving more lives. Inadequate education for profession, including ethnic issues, might have contribute to this situation.
Ming-Yuan Tseng, Taiwan

Hard penalties should be possible and available to those who close ranks instead of the victim being penalised.

Joan Lisa, USA
As a victim of med mal-practice the ranks were closed even when I was in the emergency room a few days after surgery. If it hadn't been for one doctor who speeded up the process to get me an ultrasound the blood clot wouldn't have been mentioned at all, considering that I was sent home with it after it occurred during a minor day surgery, simply because no one bothered to pay attention to my family medical history.
t was my first encounter as a patient to begin with and I fervently gave everyone I saw - the surgeons, assistants, anestheologist, lab techs - my family's history and watched while they wrote it all down. To no avail. A simple procedure would've prevented my being at death's door and hearing "Don't MOVE!" in emergency, as well as much pain still as well the leg being twice than normal size and medication for the rest of my life.
Hard penalties should be possible and available to those who close ranks instead of the victim being penalised.
Joan Lisa, USA

On the face of it , it would be ideal for all mistakes be exposed and discussed. Politically convenient but then look at the wider picture and expose all miscreants in all professions. How many times are we subjected to mistakes, blatant and exposed by mechanics, builders, bankers and politicians. What is done? There is not even a sympathetic forum easily approached. Yes, let all professions be made to expose mistakes and face similar consequences. Not for political capital or popular slogans.
Dr H Bhogal, UK

Doctors hold an esteem place within our society, whether rightly or wrongly is another matter. As a registered nurse I see the good and the bad in the medical profession. Some doctors I have worked with appear to have a god complex-most prevalent amongst consultants. They believe that they are infallible and answerable to no-one except their immediate peers (try complaining about a hospital doctor and you'll see what I mean). I feel that doctors should become as accountable as nurses are these days, the medical profession needs much more transparency of actions if it wishes to maintain the respect of the rest of society.
Mark McCulloch, UK

Perhaps the way forward is a sytem of no-fault compensation for medical accidents

Dr Julian Spinks, UK
As a doctor, I am faced with the ever present possibility of making mistakes. Medicine is not a precise science. Serious illnesses can mimic minor ones (and vice versa). As a result I can do everything right but still get it wrong.

When I am faced with a situation where I have made a mistake, I do my best to explain what has happened to my patient. In addition my group practice has regular meetings to review cases where there have been problems of whatever cause so that we can learn from our mistakes.

This openness ironically places me at greater risk of complaints and litigation than other doctors who hide their mistakes.

Perhaps the way forward is a sytem of no-fault compensation for medical accidents. This would encourage doctors to admit their mistakes and those who have suffered would benefit from avoiding the need for lengthy legal proceedings.
Julian Spinks, UK

Would you publicise your mistakes if you knew they would lead to lawsuits against you? Doctors won't either, unless they receive some sort of legal immunity. But they do play with lives. Well, every profession has its lucky breaks and priviliges.
Ulysses Christodoulou, USA

A doctor's record should be revealed the same as the record of a professional athlete's career statistics. If a individual does well, you'd think they would want to have their information available for all to see, and if the information is readily available, it would put even greater emphasis on a doctor to strive for success.
Stephen Kenney, USA

The only way to correct it is a complete change in management and professional education

Mikko Toivonen, Finland
It does not only apply to medical doctors. Serious mistakes should not be hidden in any profession. It is a simple question of basic morale. This morale is unfortunately missing almost totally in any profession.

The attitude is fed by bosses and institutions who make any attempt to avoid any responsibility. Medical doctors cannot be singled out for being similar to other professionals. The issue is much wider.

The only way to correct it is a complete change in management and professional education. Once we have the management naturally adopt responsibility and basic morale then they can transfer it to workforce and thus into society.
Mikko Toivonen, Finland

I cannot speak for British opinion, but in America the word malpractice would scare many physicians away from opening up about their mistakes. People should realize that physicians are not gods, and things can and do go wrong.

Managed Care Practices do not allow for all the extravagant medical tests that doctors had at their disposal in the past. My son suffered first, second and third degree burns on 28% of his body and his paediatrician didn't refer him to a plastic surgeon as he thought they were only first and second degree burns.

Since then my son has undergone two operations to correct his scarring and still is not 100%. I still would not see an attorney because despite his misjudgement, he is a wonderful doctor. Until America gets its problems with Managed Care and Medicare reimbursements straightened out, I'm afraid we are going to see more unessessary deaths.
Glenda, USA

All professions are a conspiracy against the common man

Mohan Singh, India
The Shavian maxim that all professions are a conspiracy against the common man applies. A doctor's mistakes are not revealed to the patients because they belong to the exclusive club of medical practitioners.

Because of the espirit de corps and misplaced loyalty to fellow members, doctors are loathe to pin the responsibility on to those who have failed in their professional duties. The result is incompetent doctors continue to practise, leaving the trusting, gullible public at risk.

However, transparency on the part of the medical profession is unlikely to help the common man either. It is likely to lead to litigation - yes, you have guessed it - the public becomes a prey to another profession, lawyers, who make money out of others' misery.
Mohan Singh, India

The medical profession should have a worldwide database on the human mistakes made. Surely there are clever applications to share special methods etc, but sharing malpractices has to date been a private, well-shielded affair.

Any medical centre should regularly access this to be developed malpractice prevention system (MAPS) and notify staff of comparable calamities before a similar operation takes place. MUPS will no doubt provide a platform to try and prevent similar malpractices.

Please note that such system should only be used by the medical profession and never be opened to the public. A good Code of Practice will ensure that the person is shielded, and only the medical institution may be named. So with "MUPS" all malpractices can be logged without jeopardising the unfortunate doctor. Corrective action is only in the hands of the Medical Council and the Law, not Joe Public

We have to realise that doctors are human and liable to make mistakes

Selva Appaswamy, USA
The mistake is not the problem. It is what follows once the mistake is made that is. The way the whole medical establishment gang up together, the way you are stonewalled when you try to get information, the way suddenly your records disappear and the way everything is loaded against you when you try to get justice, simply because the people there to ensure justice is done have vested interests.

Not until you have a system that is fair and impartial and resolute in their goal for justice that you will have a decline in the number of mistakes. At the same time we have to realise that doctors are human and liable to make mistakes therefore that element needs also to be taken into consideration.
Selva Appaswamy, USA

Instead of having doctors confess their mistakes, I'd like to see them confess their ignorance. All too often patients with diseases their doctors don't recognize are referred to psychiatrists and psychologists, when the basis of their diseases are physical.

Many of these patients may never be referred to the specialist who would recognize the set of symptoms, mainly because the referring doctor is too egotistical and too self-absorbed to admit he or she doesn't recognize every disease in the book
Charlene, Canada

The huge culture of blame encourages doctors to "hide" their mistakes

Helen H, UK
The problem with the health profession accepting and acting to prevent medical negligence in a more pro-active way, is the huge culture of blame and expensive litigation that is developing in this country, which encourages doctors and nurses to 'hide' or 'sideline' their mistakes.

Another problem is that the public has simply unrealistic expectations of a cash-limited health service, which ultimately cannot prevent all ill-health.

For example, think of all the people who disbelieve and wrongly criticise their doctor because he won't prescribe an expensive antibiotic for thier flu-like illness? The public need to be realistic and the government need to be honest and supportive, in order to get the profession to honestly and openly look at its mistakes.
Helen H, UK

No,not in present situation of prevailing lawsuits againset medical doctors. It will only further deterioate doctor-patient relationship.
Lalita Vijay, USA

Having just begun to read the The report of the Institute of Medicine (USA) that has prompted the current discussion of medical mistakes, I notice that the BBC does what the USA press does and states "up to 100,000" deaths.

I wish to suggest that a rational discussion must be based on facts, not exaggerations. The study was based on two reports: i) a 1984 Harvard study of New York State hospitals which was extrapolated to the USA national figure of 98,000. ii) a 1992 study of Colorado and Utah which extrapolated to 44,000 deaths.

There 45.000 randomly chosen discharges in the combined studies. This is hardly new data and how representative the data are considering the difference of 44,000 and 98,000 is questionable. 100,000 does make better headline.

The potential risk of error should be addressed and is too high in some cases but it should be assesed with some regards to the benefits. I think we are all intelligent enough to realize that life is not risk free.
Phil Long, USA

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