Nobody likes mistakes
From the Archives of Internal Medicine
Most respondents agreed that reporting errors improves the quality of care for future patients (84.3%) and would likely report a hypothetical error resulting in minor (73%) or major (92%) harm to a patient. However, only 17.8% of respondents had reported an actual minor error (resulting in prolonged treatment or discomfort), and only 3.8% had reported an actual major error (resulting in disability or death). Moreover, 16.9% acknowledged not reporting an actual minor error, and 3.8% acknowledged not reporting an actual major error. Only 54.8% of respondents knew how to report errors, and only 39.5% knew what kind of errors to report. Multivariate analyses of answers to hypothetical vignettes showed that willingness to report was positively associated with believing that reporting improves the quality of care, knowing how to report errors, believing in forgiveness, and being a faculty physician (vs a resident).
Doctor hypocricy is still news to most people, but I find it hard to understand why. Anyways, it looks from this study that while 90% of the study’s participants said they would disclose a major medical error and 73% a minor error, only about half of the people who had seen either type actually reported it to the institution. But what’s really amazing to me is the low number of physicians who report having committed a medical error at all (just under half, according to this table). The IOM, on the other hand estimates that about 1-2% of admissions end up with adverse events due to medical error and 0.15-0.3% mortalities. To put this in perspective, an average intern will probably admit at least 150 patients per year (generous assumptions are 8 call months, 7 call nights per month, 3 patients per call). That’s just the first year; second and third year residents probably see double those numbers, which suggests that on average, an internist entering practice should already have at least five errors resulting in minor harm, and one in death. Now maybe you think that high, and it probably is (among other things, errors probably cluster in certain fields and among certain doctors). But I think the commonness of errors in general suggests that they are grossly underreported on this survey.
Why is this? I can think of a few answers, most of which the study authors think of as well. One is that even on anonymous surveys, people are loathe to make damning self-revelations (oddly, they do better at this when they are surveyed via computer, and it wasn’t clear how this survey was performed).
Another, more difficult to overcome, is that errors are easy to identify in a sterile research scenario but harder to identify in practice. They are difficult to define. Especially when patients are otherwise sick and complicated, the actual harm attributable to any action by a physician is difficult to determine. The difference between an error and a shortcut that backfires (say, taking a preexisting allergy list as correct rather than verifying it with the patient) is blurry; when time is at a premium, one has to be able to trust some parts of the record.
A third is that we are good at forgetting things.