Let's not err in our attempt to correct medical errors

AMA Leader Commentary. By D. Ted Lewers, MD, chair of the AMA Board of Trustees. June 5, 2000.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from D. Ted Lewers, MD, chair of the AMA Board of Trustees.

When the Institute of Medicine's provocative report, "To Err Is Human," surfaced last year, you probably wondered where the news was in the report.

The data, recorded in 1984 and interpreted in a journal article in 1991, suggest that medical errors kill some 44,000 to 98,000 people each year in U.S. hospitals.

If true, the 98,000 deaths would make medical errors the fifth leading cause of death in this country -- behind heart disease (727,000), cancer (540,000), stroke (160,000) and chronic obstructive pulmonary disease (109,000) as reported by the National Vital Statistics Reports.

Without arguing with the numbers, it is clear that one medical error is one too many. The question isn't "How many and where?" but "What can we do to prevent and reduce errors in the first place?"

With that motive in mind, the AMA Board of Trustees has approved a set of specifications that proposes that the responsibility for preventing and reducing errors resides in the Agency for Healthcare Research and Quality.

Our recommendation is that AHRQ, through a private-public advisory committee, set a number of parameters for any reporting programs that include such controls as:

Guarantees of patient and individual provider confidentiality.
Adequate immunity for program participants.
Administrative ease and care to avoid unduly intrusive procedures for patients and program participants.
A nonpunitive process geared toward facilitating feedback, education and learning.

As I observed in this column in the Jan. 3/10 AMNews, " 'First, do no harm' is more than an ideal. It's a way of life.

"Preventing error extends well beyond the examining room, operating room and laboratory. It includes prudent care in all our actions."

Our goal has been -- and continues to be -- creating a culture of safety, learning and improvement, not of lawsuits, trials and punitive damages.

Medical care is increasingly complex, and our procedures and therapies are more intricate than ever. That complexity, with its inherent potential for unintended error, is the price of better treatment and, ultimately, longer and healthier lives for our patients.

At no level should we tolerate error. At every level, including the federal, we should learn from it. AHRQ as a nonregulatory organization is the proper place for this issue, especially if it remains true to the ideal of creating a culture of safety. The Wall Street Journal pointed out one promising aspect in the IOM report -- a point worth retaining. The estimates of death from medical errors, it said, "are extrapolated from hospital records in just three states: 98,000 from hospital records in New York in 1984 and 44,000 from Colorado and Utah in 1992."

The telling point: "Assuming these numbers are representative, they indicate not just the upper and lower limits of estimated errors but a significant decline over eight years."

My hope, and I'm certain yours as well, is for that trend to continue until there are virtually no deaths or serious injuries from medical errors.

Anywhere.

At any time.

Tell me what you think. E-mail me.

Dr. Lewers of Easton, Md., a nephrologist and internist, was AMA board chair during 2000-01.