Physicians, public at odds over errors

Researchers report that patients and doctors disagree over the best way to curb medical mistakes.

By Andis Robeznieks, amednews staff. Jan. 13, 2003.

The surprising aspect of a recent study on medical errors wasn't that so many people had been affected by them, but that the public and practicing physicians have such disparate opinions on the seriousness of the problem and how to fix it.

"The big finding is that physicians are relatively lukewarm about a number of proposals that have been pushed regarding reducing medical errors," said Robert Blendon, ScD, a professor of health policy at the Harvard School of Public Health. "The medical community is skeptical about the number of medical errors and the effectiveness of proposed solutions."

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Dr. Blendon led a team of Harvard and Kaiser Family Foundation researchers who surveyed 831 physicians and 1,207 adults on the subject of medical errors.

According to their report, which was published in the Dec. 12, 2002, New England Journal of Medicine, 35% of the doctors surveyed and 42% of the public reported experiencing a medical error in their own care or in the care of a family member. Of these, 18% of the physicians and 24% of the public said the error had caused serious consequences such as death, long-term disability or severe pain.

Despite these numbers, only 5% of the doctors and 6% of the public saw reducing medical errors as a top health care concern. Physicians listed medical liability insurance costs and lawsuits as their top concern (29%), with health care costs close behind (27%). The public picked health care costs (38%) and prescription drug costs (31%) as its top concerns.

Proposed procedures and policies aimed at reducing errors were the subject of widely differing opinions between the public and physicians. According to the survey:

71% of the public felt reporting errors to a state agency would be an effective way to reduce errors; only 23% of the doctors surveyed agreed.
66% of the public thought reducing the work hours of doctors in training would help reduce errors; only 33% of physicians thought so.
62% of the public believed error reports should be public information; 14% of physicians agreed.

71% of the public think reporting would cut medical errors; 23% of doctors agree.

"I think it's sort of natural," Dr. Blendon said. "Physicians live in an environment where there are problems every day. The public is on the outside, but they want to be protected. They say: 'I want you to take every single step you can to protect me.' "

Dr. Blendon and Robert L. Wears, MD, a professor of emergency medicine at the University of Florida Health Science Center in Jacksonville, both noted how members of the general public were more apt to push for punishing individuals involved in a medical error.

"If a mistake is made and somebody dies, they believe there has to be [a] sanction," Dr. Blendon said.

Of those surveyed, 50% of the public thinks suspending the licenses of medical professionals involved in an error is a "very effective" way of reducing mistakes, but only 3% of the physicians thought so.

Dr. Blendon said it's important for physicians to know the attitudes of the public because, ultimately, these attitudes will affect lawmakers. Dr. Wears, however, said it was up to the medical community "to do a better job of cleaning up our own houses."

"The public wants to know 'who done it' and feels exposure and punishment will solve the problem," Dr. Wears said. "Ultimately though, the public doesn't care how we get better. If we get better, they'll be satisfied."

No easy answers

Dr. Wears also noted that the public and media look for quick fixes, and medical errors are often the result of complex system breakdowns that don't lend themselves to easy answers. He said he was somewhat amused by a Washington Post report that said little had been done to reduce errors since the Institute of Medicine's 1999 report, which estimated that up to 98,000 Americans die each year because of medical mistakes.

"It said, 'It's been three years since IOM reported the problem. Why hasn't it been fixed? What villains are keeping it from happening?' " he said.

62% of the public think error reports should be made public; 14% of physicians agree.

Dr. Wears, who has spoken and written extensively on patient safety, acknowledged that many physicians are resistant to proposed solutions for reducing medical errors. But instead of criticizing these doctors, he said, attempts should be made to understand the reason for their resistance.

"I think it's a little more complex than what came out in the popular press, and I think the resistance comes in a couple forms," he said. "In general, there's a great deal of denial that the situation is as bad as the IOM report said it was. And the resistance also deals with other dimensions of the proposed solutions."

The survey found little support from doctors for three error-reducing strategies proposed by The Leapfrog Group coalition of major employers. These include using computerized order entry of prescriptions, using only physicians with special intensive care training in intensive care units, and limiting certain high-risk procedures to hospitals where a large volume of these procedures are performed.

"For computer-order entry, the resistance is not based on the opinion that people don't think it won't help, it's more that every physician has had interaction with bad computers -- just about every person has," Dr. Wears said.

He added that many physicians thought the proposal to staff ICUs with specially trained "intensivists" was unrealistic because there are not enough intensivists to go around.

"Intensivists are not going to magically appear just because we decided it's a good thing to have them," Dr. Wears said, but he explained that there's another factor behind resistance to the Leapfrog proposals.

"In all three of these interventions, there is an element of increasing centralization of control," he said.

Although the IOM report has been met with skepticism, both men agreed that little would be accomplished in repeating it. Instead, Dr. Blendon said energy should be focused on studies proving the effectiveness of error-reduction strategies and on disseminating patient safety information.

"These things have to be discussed -- and not just in a national commission," he said. "I think it's important for hospital and medical staffs to discuss this and for specialty societies running CME programs to get involved. The focus has to be on educating the practicing physician."

ADDITIONAL INFORMATION:

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Article, "Views of Practicing Physicians and the Public on Medical Errors," New England Journal of Medicine, Dec. 12, 2002 (vol. 347, issue 24) (http://content.nejm.org/cgi/content/full/347/24/1933)