To err is human… except in medicine

Physicians are held to higher standards than anyone else. To some extent, this is natural – lives are at stake. However, society and law has taken this to a ludicrous extreme, with the expectation that any mistake that happens is due to negligence. When any undesirable outcome occurs, the blame is placed squarely upon the doctor, who it is assumed has “botched the job.”

Who Botched the Job

Even by a higher standard, doctors cannot be expected to be infallible. Not even machines work perfectly. Error rates can be very, very low – as low as 1 per million – but the chance error is not just possible, it is inevitable.

Many studies have been conducted to identify error rates in medicine, but let’s take one such study as an example: that for every 1000 prescriptions written, there are four errors. Is this negligence? No. This is the inevitability of probability. No one can be perfect, no matter how hard they try.

Now, there may be ways to reduce the error rate. Cajole doctors into writing neater, require a second doctor to review the prescription before it can be filled, develop a computerized system, etc. But any technique in quality control is about *reducing* error – not about *eliminating* error.

Consider, then, the malpractice lawsuit. A patient had an adverse outcome to a prescription written in error. The error was obvious post-facto. That patient happened to be one of the four unlucky ones. Did the doctor botch the job – display gross negligence, even incompetence – because she, as an average doctor, has an error rate on par with average?

The legal system has turned medicine into a casino. Errors happen, often not because of negligence but because of statistical inevitability. But when statistical inevitability is treated as negligence, when the average doctor is sued three times over the course of her career, the entire field begins to take a defensive posture, which ultimately reduces efficiency and quality of care.

 

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One response to “To err is human… except in medicine

  1. Analysis of errors has determined that medical errors happen in a context of several safety systems breaking down at the same time. The doctor wrote the wrong name followed by the nurse checking the room number rather than the name, while the nurse who knew the patient was unavailable at that moment.

    Errors may not ever reach zero, but when insurance companies, including Medicare, seek to lower medical costs rather than improve care by paying more for better care, the only expectation is for increased errors in an over stressed system.

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