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Medical Errors: Causes and Solutions

We all make mistakes, after all, to err is to be human.  However, imagine a population the size of Miami, roughly 400,000, needlessly wiped out on a yearly basis due to preventable medical errors, and the scope of this epidemic quickly comes into focus. Iatrogenic mortality (death caused by medical care or treatment) is now considered thethird leading cause of death in the United States. The majority of these errors were medication related and occurred in the hospital setting, harming 1.5 million others who were fortunate enough to escape death. The operative word here is ‘preventable’ since life itself carries risk and unavoidably ends in death for all. Additionally, certain diseases lead to death despite any heroic attempts to treat and/or cure.

Medical error is defined as a preventable adverse effect of medical care whether or not evident or harmful to the patient. Often viewed as the human error factor in healthcare , this is a highly complex subject related to many factors such as incompetency, lack of education or experience, illegible handwriting, language barriers, inaccurate documentation, gross negligence, and fatigue to name a few. There are also many different types of errors ranging from medication errors, misdiagnosis, under and over treatment, and surgical mishaps. Medical errors are also associated with extremes of age, new procedures, urgency, and the severity of the medical condition being treated.

Are medical errors happening more frequently over time? It would appear that way since a 1999 study estimated98,000 iatrogenic deaths making it the sixth leading cause of death in the U.S. A later study in 2010 yielded almost twice that many deaths, at 180,000. The most recent study in 2013 suggested the numbers range from 210,000 to 440,000 deaths per year. The latter number would make it the third leading cause of death after heart disease and cancer. However, which number is accurate? No one really knows since these deaths can only be estimated and extrapolated. For example, how is it possible to measure deaths due to treatments that should have been provided but were not? Medical records are often inaccurate and providers might be reluctant to disclose mistakes.

It might be a waste of time to quibble over the exact numbers since all would agree the numbers are simply too high and unacceptable in our relatively affluent and medically sophisticated society. Studying the sources of errors and implementing ways to correct the problem, i.e. prevention, seem to be a more reasonable use of time, energy, and money.  In 2000, The Institute of Medicine published “To Err Is Human” which concluded medical errors are not caused by ‘bad people’ but in general are caused by good people working in bad healthcare systems that must be made safer. Just how is our healthcare delivery system faulty? First, increased cost cutting has certainly contributed to compromised patient safety.  For example, these days, physicians are often being forced to see two or even three times as many patients in a day!  Biased provider judgment, fragmented communication including illegible record keeping, sleep deprivation, and lack of continuing education and training are some other common error sources.

Minimization or outright denial that errors exist in the first place will without a doubt ensure the perpetuation of this problem. Recognizing that errors are not isolated events as much as part of a process that needs correcting is paramount. Certainly, disclosure and transparency along with checks and balances, without finger pointing, would have the overall effect of improving the chances ‘that mistake doesn’t keep happening.’ Medication errors are far too common. For example, a physician orders the anxiolytic Klonopin 0.5 mg three times daily for a grieving patient for a week. This gets incorrectly transposed into the EMR as clonidine 0.5 mg three times daily. The pharmacist quickly realizes the unusually high dose of clonidine and in reviewing the patient’s history does not see a diagnosis for hypertension or any other indication for this potent alpha-adrenergic agonist. He/she then contacts the physician for clarification, the ‘similarly named drug’ error is identified, and a potentially catastrophic event is aborted. Perhaps, since this particular example is a fairly common error, a ‘name alert’ flag could be instituted when either of these drugs is prescribed. Zantac and Xanax is another common example of similarly sounding medications.  Granted, this is a rather simple example of the much broader topic of medical errors, which might include much more dramatic and horrific errors such as an incorrect final sponge count during surgery, an incorrectly tagged limb for amputation, and perhaps the most feared of all:  paralyzed but not unconscious during a painful surgical procedure due to incorrectly administered anesthesia.

Hopefully, this quick overview of the medical error epidemic, along with its frequently devastating consequences, will shed some light on the subject of patient safety keeping in mind these errors are preventable. Is the complete abolition of medical errors even a remote possibility? The answer is probably ‘no’ as long as humans are providing healthcare. However, when the stakes are high whether it be with an airline pilot or a neurosurgeon, ‘oops, I made a mistake’ is simply not acceptable. Placing a higher value on patient safety by tackling these errors at the source may be the only way to prevent the numbers of harmed or dead patients due to medical errors from continuing to climb.

Michael Murphy, MD
Dr. Michael Murphy is co-founder and Chief Executive Officer of ScribeAmerica, LLC. He co-founded ScribeAmerica in 2004, and it is now the country’s largest and most successful medical scribe company with a staff exceeding 7200 employees operating in over 46 states nationwide. Today, ScribeAmerica is the recognized leader of the medical scribe industry and remains at the forefront of professional scribe education, training, and program management nationally. Dr. Murphy served as an Army Ranger for the 1st Ranger Battalion in Savannah, Georgia, which allowed him to gain various leadership skills along with the ability to develop standard operating procedures. He applies this to his daily duties for ScribeAmerica. Dr. Murphy has been a leader on multiple issues including scribe policy, hospital throughput, electronic medical record implementation and optimization of provider to patient ratios. His goals are to continue making all medical practice locations an environment built for an exceptional patient experience that allows providers to focus solely on patient care. Dr. Murphy received his Doctor of Medicine from St. George's University and completed his residency training in Emergency Medicine at the University of Medicine and Dentistry of New Jersey in Newark. He has co-authored one textbook and is involved in 3 peer review articles.
Posted In: General On: Tuesday, 26 August, 2014

8 Comments

  • Karen T - January 17, 2016

    Well-written. I spent years taking detailed histories & transcribing for a surgeon, with accuracy the prime objective to prevent errors. I’ve just had 2 consults with a neurosurgeon who, despite my complaint to the practice manager after the 1st report, STILL doesn’t have my many drug allergies listed, has 2 incorrect drugs because the software doesn’t allow for compounded meds (so they just listed something on the list that’s wrong), and has only 20% of my medical and surgical history. I submitted a very detailed and typed intake form. When I called him on the missing history at my last visit, he said “is any of it major”? With 4-level neck fusion recommended, at my last visit I reviewed again my severe adhesive allergy, and showed pictures of the 2-week chemical burn caused by a prior surgeon’s arrogance & lack of documentation (despite multiple preop discussions). This new surgeon did not include in his records any aspect of our several-minute talk on how to avoid the allergy, and the adhesive allergy is STILL not listed. Those reports are the basis for hospital admission & orders. I now have no faith that he or his staff can do what’s needed to safeguard my general health, or avoid a known severe reaction which 1) will increase the risk of wound infection, 2) cause me additional pain and lak of sleep, and 3) the need for otherwise unnecessary drugs to combat that allergic reaction.

    Also, he’s never examined me at all, but the reports detail full exams; he’s never touched me. He copied/pasted the findings of a 5-month-old exam by a partner, done when the pain & neurologic dysfunction were much less severe. Will find an honest surgeon who cares about my health.

    Reply
  • Joan Kipkeu - March 6, 2018

    your page is educative

    Reply
  • Joan Kipkeu - March 6, 2018

    educative

    Reply
  • You shared a very good points that we should be all aware of this issues. Constant mistakes is not acceptable at all. Errors or negligence can cause a big trouble for the patients. Who will take responsibility on the medical errors? Seeking for second medical opinion is highly suggested.

    Reply
  • Innocential - January 17, 2019

    Interesting, thank you.

    Reply
  • Bman - February 18, 2019

    thanks this really helped me with my schoolwork

    Reply

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