Complexity and Error in Medicine

How medical errors are made

Error is to be human.

We all know that mistakes occur whether we like them or not. These little unexpected and unintended actions continue to make our lives difficult. Some maintain that they are an inevitable consequence of our limited abilities while others believe they are purely caused by a lack of skill or effort or both.

The magnitude of medical errors

Is enormous

The year 2000 report, Err is Human stirred a debate on one of the most under-considered aspects of death statistics. The document revealed that medical errors killed more people than traffic accidents. It concluded that 44 to 98 thousand people were dying due to preventable errors and costing the national budget of the USA an annual $17 to $29 billion.

The situation is still far from satisfactory in the third decade of the century. Another report published in BMJ back in 2016 by the team of doctors in John Hopkin’s university estimated more than 250 thousand patients die annually because of preventable errors in hospitals. The report places medical errors as the third biggest cause of death after heart diseases and cancer.

The human cost of medical errors

Is enormous and often irreversible.

But, fortunately, most are not so dangerous. The outcomes of such errors can be as trivial as delay in receiving medicine dose to as deadly as death. The specific circumstances in which error is committed and the nature of it often dictates its outcomes. For example, giving two doses of paracetamol instead of one to a patient in the ward for headache is no problem. But, missing to check life-saving adrenaline infusion to a patient on cardiac support is lethal.

Can we ever end them?

Being realistic, probably no.

But we can minimize them.

Several strategies are being employed to curb the events of mistakes in medicine. The first and foremost is identification and reporting of errors especially when they are mishits i.e. an error was made, but no harm occurred. These are golden opportunities for staff and for the organization as a whole that call for a change in attitude and practices to prevent such future event.

Why errors occur in medicine

The simple answer is complexity.

Practising medicine has evolved substantially in the last century. While the absolute quality of it has improved undoubtedly, its complexity has grown up too. Making it harder and harder to practice it safely.

As physicians, there are a number of investigations to perform before you get a definitive diagnosis, often with some degree of doubt still present. Increased choices for treatment with little difference in certain aspects, make decision making tedious. On top of all, providing elaborate information to the patient and putting the burden of decision on their shoulders complete the process of making things complex.

Hospitals are complicated organizations where people with different knowledge, skills, culture, and authority work together to take care of the sick. The traditional direct doctor-patient relationship is now shared by many people working behind the scenes to make treatment reach patients in a safe and efficient way.

What is the best solution?

Simplification

Although the world is complex, its the simplicity which make things go smoothly. The day to day workplace chores of a medical professional should be simplified and eased. This ensures the physician is able to concentrate fully on his job of dealing with the patient, instead of trying to avoid a possible future legal consequence.

The doctors are supposed to document a lot of their actions to make sure they are not misunderstood in case of enquiry. This anxiety of being judged in the future turns their mindset from helping and caring, to documenting and saving their own prestige.

When I counsel a patient about the potential side effects of treatment, I have to tell them the most trivial of the possibilities, that make them obviously anxious. While we try to complete the process of informed consent, the patients are forced to feel, that the doctors are trying to cover their own lack of skills and knowledge. This turns the meeting into a complex mix of assumptions, facts, suspicion and blame.

Take home

Errors in medical practice are a reality that deserves attention. The goal is to avoid them through continued commitment and surveillance. The safety practices should aim to simplify the work environment instead of complicating it further through documentary checks and balances. An air of trust and empathy is the way forward to create an environment where both patients and doctors support each other.