Letters to the Editor - Sept. 20, 2004

Reduce medical errors by identifying and modifying risk factors - Blur of complicated mounds of medical records can lead to errors from lost information

Reduce medical errors by identifying and modifying risk factors

Regarding "Edwards' trial lawyer past raises red flags for doctors" (Article, Aug. 2): Sen. John Edwards trotted out the usual complaint of the tort bar: "We need to reduce the number of medical errors, many made by a very small fraction of the medical profession."

I have been hearing this refrain about "bad apples" for the more than 20 years that I have been in practice. At the present time I work in a hospital system with almost 1,000 beds and only eight general surgeons taking call. I am told we provide portions of care for almost 1 million people in our area.

I would like to know who all these bad apples are and how many of them can possibly be left after the tort bar has spent 20 years rooting them out.

What I see is a small and very dedicated group of surgeons who work very, very hard. Instead of being helped by the system, we become the scapegoats if there is any big problem that occurs or any bad outcome.

What we need to understand is that all of the bad apples are gone. They have been weeded out of the system in a very Darwinian way.

If we are going to improve medical care, it has to be by the development of new systems of identifying risk factors and modifying those risk factors.

This probably will not make the tort bar very happy, because it will mean confronting the issue that some patients are much higher risk than others and that these patients may need to be treated in different ways or to be treated for much higher reimbursement. Alternatively, such patients may not be given access to recovery if bad outcomes occur.

It also means that much of our current system of "peer review" needs to be thrown out.

We need to track outcomes of patient care objectively and measure whatever we can do better. We also need to measure where bad outcomes are likely, no matter who is taking care of the patient. We need to get our heads out of the sand, so to speak.

--F. Andrew Morfesis, MD, Fayetteville, N.C.

Blur of complicated mounds of medical records can lead to errors from lost information

Regarding "Communication problems often initiate 'cascades' of errors" (Article, Aug. 16): While the errors you discuss are certainly present, we should recognize that errors of this sort are not merely "communication" errors, but errors of "information transmission."

As the amount of information in each patient's medical record grows, including mounds of paper reflecting HMO referrals, coverage denials, UR review results, etc., in addition to clinical records, much of the important information becomes a blur, and inaccessible in the few minutes a primary care physician has to see a patient today.

Electronic medical records will make great improvements in this aspect of care, but not until even the smallest practices can afford to purchase a system, convert old records and train physicians and staff. Until all of the above is done, the errors will continue, patients will suffer and physicians will have much greater liability exposure.

Let's bring medicine into the 21st century and save lives as well as lawsuits.

--Eric E. Shore, DO, Bala Cynwyd, Pa.