MedicalConspiracies- Medical Error "Well, we did our best. These things happen."

Medical Error

"Well, we did our best. These things happen."
At least 100,000 hospital patients dying each year due to medical
malpractice in the U.S.
"Substandard or negligent care have been swept under the rug" by the
medical profession for too long.

"'The person most likely to kill you is not a relative or a friend, or
a mugger or a burglar or a drunken driver. The person most likely to
kill you is your doctor."
---- Vernon Coleman, author - What Doctors Don't Tell You

It's a wonder any of us makes it out of the doctor's office or
hospital alive

Physicians SHOULD disclose to patients information about procedural or
judgment errors made in the course of care

A 2000 Institute of Medicine report estimated that medical errors are
estimated to result in about between 44,000 and 98,000 preventable
deaths and 1,000,000 excess injuries each year in U.S. hospitals.[

^ Zhang, J., Patel, V.L., & Johnson, T.R (2008). "Medical error: Is
the solution medical or cognitive?". Journal of the American Medical
Informatics Association 6 (Supp1): 75–77. doi:10.1197/jamia.M1232.

A medical error is a preventable adverse effect of care, whether or
not it is evident or harmful to the patient. This might include an
inaccurate or incomplete diagnosis or treatment of a disease, injury,
syndrome, behavior, infection, or other ailment.

The American Medical Association's Council on Ethical and Judicial
Affairs states in its ethics code:

"Situations occasionally occur in which a patient suffers significant
medical complications that may have resulted from the physician's
mistake or judgment. In these situations, the physician is ethically
required to inform the patient of all facts necessary to ensure
understanding of what has occurred. Concern regarding legal liability
which might result following truthful disclosure should not affect the
physician's honesty with a patient."

From the American College of Physicians Ethics Manual[62]:

"In addition, physicians should disclose to patients information about
procedural or judgment errors made in the course of care if such
information is material to the patient's well-being. Errors do not
necessarily constitute improper, negligent, or unethical behavior, but
failure to disclose them may."
However, "there appears to be a gap between physicians' attitudes and
practices regarding error disclosure. Willingness to disclose errors
was associated with higher training level and a variety of patient-
centered attitudes, and it was not lessened by previous exposure to
malpractice litigation".[63] Hospital administrators may share these
concerns.[64]

Consequently, in the United States, many states have enacted laws
excluding expressions of sympathy after accidents as proof of
liability; however, "excluding from admissibility in court proceedings
apologetic expressions of sympathy but not fault-admitting apologies
after accidents"[65]

Disclosure may actually reduce malpractice payments.[66][67]

[edit] Disclosure to non-physicians
In a study of physicians who reported having made a mistake,
disclosing to non-physicians sources of support may reduce stress more
than disclosing to physician colleagues.[68] This may be due to the
physicians in the same study, when presented with a hypothetical
scenario of a mistake made by another colleague, only 32% physicians
would have unconditionally offered support. It is possible that
greater benefit occurs when spouses are physicians.[69]

[edit] Disclosure to other physicians
Discussing mistakes with other doctors is beneficial.[48] However,
doctors may be less forgiving of each other.[69] The reason is not
clear, but one essayist has admonished, "Don't Take Too Much Joy in
the Mistakes of Other Doctors."[70]

[edit] Disclosure to the physician's institution
Disclosure of errors, especially 'near misses' may be able to reduce
subsequent errors in institutions that are capable of reviewing near
misses.[71] However, doctors report that institutions may not be
supportive of the doctor.[48]

[edit] Use of rationalization to cover up medical errors
Based on anecdotal and survey evidence, Banja[72] states that
rationalization (making excuses) is very common amongst the medical
profession in covering up medical errors. Common excuses made are:

"Why disclose the error? The patient was going to die anyway."
"Telling the family about the error will only make them feel worse."
"It was the patient's fault. If he wasn't so (obese, sick, etc.), this
error wouldn't have caused so much harm."
"Well, we did our best. These things happen."
"If we're not totally and absolutely certain the error caused the
harm, we don't have to tell."
[edit] By harm or not harm to patient
A survey of more than 10,000 physicians in the United States came to
the results that, on the question "Are there times when it's
acceptable to cover up or avoid revealing a mistake if that mistake
would not cause harm to the patient?", 19% answered yes, 60% answered
no and 21% answered it depends. On the question "Are there times when
it is acceptable to cover up or avoid revealing a mistake if that
mistake would potentially or likely harm the patient?", 2% answered
yes, 95% answered no and 3% answered it depends.[73]

Legal procedure

Main article: Medical malpractice
Standards and regulations for medical malpractice vary by country and
jurisdiction within countries. Medical professionals may obtain
professional liability insurances to offset the risk and costs of
lawsuits based on medical malpractice.

[edit] Methods to improve safety and reduce error
Further information: Patient safety
Medical care is frequently compared adversely to aviation: while many
of the factors that lead to errors in both fields are similar,
aviation's error management protocols are regarded as much more
effective.[80]

patient's informed consent policy
patient's getting a second opinion from another independent
practitioner with similar qualifications
voluntary reporting of errors (to obtain valid data for cause
analysis)
root cause analysis
Electronic or paper reminders to help patients maintain medication
adherence
systems for ensuring review by experienced or specialist
practitioners[81]
hospital accreditation
[edit] Reporting requirements
In the United States reporting medical errors in hospitals is a
condition of payment by Medicare.[82] An investigation by the Office
of Inspector General, Department of Health and Human Services released
January 6, 2012 found that most errors are not reported and even in
the case of errors that are reported and investigated changes are
seldom made which would prevent them in the furture. The investigation
revealed that there was often lack of knowledge regarding which events
were reportable and recommended that lists of reportable events be
developed. [83]

[edit] Misconceptions of medical error
Common misconceptions about adverse events are the following, and in
parentheses are the arguments and explanations against those
misconceptions:

"Bad apples" or incompetent health care providers are a common cause.
(Although human error is commonly an initiating event, the faulty
process of delivering care invariably permits or compounds the harm,
and is the focus of improvement.[6]
High risk procedures or medical specialties are responsible for most
avoidable adverse events. (Although some mistakes, such as in surgery,
are harder to conceal, errors occur in all levels of care.[6] Even
though complex procedures entail more risk, adverse outcomes are not
usually due to error, but to the severity of the condition being
treated.).[19][84] However, USP has reported that medication errors
during the course of a surgical procedure are three times more likely
to cause harm to a patient than those occurring in other types of
hospital care.[20]
If a patient experiences an adverse event during the process of care,
an error has occurred. (Most medical care entails some level of risk,
and there can be complications or side effects, even unforeseen ones,
from the underlying condition or from the treatment itself.[85]
[edit] See also
Adverse effect
Adverse event
Serious adverse event
Adverse drug reaction
Biosafety
Complication (medicine)
Fatal Care: Survive in the U.S. Health System (book)
Iatrogenesis
Medical malpractice
Medical resident work hours
Negligence
Patient Safety and Quality Improvement Act of 2005
Patient safety and nursing
Patient safety organization
Quality Use of Medicines
Swiss Cheese model of accident causation in human systems
To Err is Human: Building a Safer Health System
References
http://en.wikipedia.org/wiki/Medical_error





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