A recent LA Times Op-Ed piece pointed out the disturbing fact that most medical errors go unreported, and that’s concerning those 26 states which require such reporting! According to the Times, “Only 1% of patient harms are reported by hospitals to state health departments in the 26 states that require them to report all of them. Since 61% of such events are caused by the acts of individual doctors, an essential conduit for reporting erring doctors is all but blocked.” The Times’ Op-Ed piece makes a thought provoking argument that runs counter to the prevailing sentiment among many experts in the health industry. Since 1999 when the Institute of Medicine published its “To Err is Human”, the majority opinion was that solutions that focused on systemic flaws would necessarily lead to safer, better medicine. Safety checklists were implemented and standard protocols were mandated. Yet, a recent New England Journal of Medicine report notes that “Most preventable mishaps in hospitals are caused by the acts of individual practitioners, not flawed systems, and there was plenty of evidence of that fact available when the committee wrote “To Err Is Human.” And studies have continued to draw similar conclusions. A 2008 analysis of 10,000 surgical patients at the University of South Florida found that, of all the complications among those patients, only 4% were attributable to flawed systems. The rest resulted from individual human shortcomings. A 2013 study from Baylor College of Medicine on diagnostic errors found that most failures to diagnose arose from deficient physician performance during doctor-patient interactions, including poor history-taking, inadequate physical examinations or ordering the wrong tests. The study suggested that systems remedies, such as checklists and electronic medical records programs, would not avoid diagnoses missed in these ways because the problem is a cognitive one on the part of doctors.” This brings us back to the point argued in the LA Times. Medical errors occur not so much because systems are flawed but because doctors make human errors. This would not be significant unless it were demonstrably true that the majority of these errors are made by the same doctors over and over again. That’s why mandatory reporting and the discipline of error-prone doctors is crucial if medical errors are ever to be reduced.
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