New Study Released On Patient Error

The medical journal, Annals Of Family Medicine, has published the results of a new study categorizing the kinds of mistakes patients may make in the course of their own health care. The study was authored by a group of doctors from New Zealand and Wales, UK and the results appear in the journal's May/June 2009 issue.

The study, titled Patient Error: A Preliminary Taxonomy (a sciency sounding word that means categorization), is controversial in my view not so much for the results -- the errors identified are common sense stuff like "forgetting to take medication" and "nonattendance" at doctor visits -- but rather for the title which sets a tone present throughout the article: Patient Error. The authors themselves admit to an inherent and likely problem with this term, that the term "error" suggests "blame." Certainly, a patient may be to blame for a given failure in health care treatment. There are undoubtedly those who would refuse to follow reasonable, clearly elucidated instructions from a physician. That obvious truth noted, the article seems defensive. "There is a need," the authors note, "to move beyond seeing patient, clinician, and system errors as separate categories of error, since they are interdependent rather than mutually exclusive." I am guessing that this "need" is perceived by the authors out of fear of medical malpractice litigation. If the death or crippling of a patient is usually due to a tangled thicket of errors by patients, doctors and "system[s]" then it is unfair to hold physicians accountable. This is a self serving, cynical point of view. Patients certainly can and should take control over their own health care. However, physicians often, in my experience, commit erroneous acts that no patient could reasonably have protected himself or herself against.

Notwithstanding the title and tone of the article, there is some value to be gained from it. For the patient and physician alike it provides a lengthy list of areas where the doctor/patient relationship can breakdown. The advice the patient can take away is educate yourself, communicate with your doctor, and cooperate where appropriate (education will help with this.) For the physician, the article provides notice of challenges that will often need to be overcome when treating a patient. For example, one of the "errors" patients purportedly make are those involving memory. Some patients are forgetful. Ask your patient if he or she has memory problems. Sometimes you'll even have a strong suspicion, especially when dealing with the elderly. Once the problem is identified, work with the patient on a solution. Have your office call the patient to remind her of an upcoming appointment. Involve a family member in reminding the patient to take his medication daily.

I sincerely hope that the publication of this article does not represent the start of a campaign in blame shifting by the medical establishment. It is undisputed that physician error is an enormous problem. To focus on laying blame for bad outcomes on patients who are often sick and vulnerable would be counter productive.