Presenters: Anton J. Kuzel, MHPE; Steven H. Woolf, MD, MPH
Institution: Department of Family Practice, Virginia Commonwealth University
Introduction: The health care community has devoted greater attention to the problem of medical errors, but limited data are available about the nature of errors in primary care. The general perception, influenced largely by hospital-based studies, is that errors harm patients primarily through adverse drug events and surgical mishaps. We sought to better characterize how medical errors affect primary care patients.
Methods: We report two studies, employing mixed qualitative and quantitative analysis of (a) in-depth interviews with 38 primary care patients in Virginia and Ohio and of (b) 75 error reports posted by family physicians over an anonymous Web-based system. Data for the latter were collected as part of a six-country international study. The 18 U.S. family physicians participating in the international study resided in Virginia, New York, Ohio, New Hampshire, and Missouri.
Results: Patients reported harms in 170 (77%) of 221 incidents, and 119 (70%) of these were psychological/emotional (e.g., anger, frustration, belittlement, loss of trust). Physicians reported harms in 30 (40%) of 75 narratives. Analysis of the narratives revealed that most incidents involved a "cascade" of events, often set in motion by a proximal error in communication rather than a clinical misjudgment. Physicians were less likely than investigators to note the psychological/emotional consequences of errors. Such consequences accounted for 17% of harms reported by physicians and 69% of those recognized by investigators.
Discussion: Cascade analysis offers great potential in exposing the anatomy of medical errors and suggests that miscommunication underlies many errors. The patient safety community may give disproportionate emphasis to the physical effects of medical errors, not appreciating the degree to which errors affect psychological and emotional wellbeing. Seeing medical errors through the lens of patients helps to better characterize medical errors and fulfills the patient-centered tenets of primary care.
Understanding Medical Errors in Primary Care
