Address Medical Errors Openly and Honestly

Medical errors account for more deaths annually than motor vehicle accidents or breast cancer; nearly 100,000 deaths every year are attributed to medical error, making it the fifth leading cause of death in the United States.

“We used to think medical errors were infrequent and the result of a few bad doctors who should be punished,” said Corey Evans, M.D., M.P.H., during a two-hour seminar “Reducing Medical Errors,” on Sept. 28 at the AAFP Scientific Assembly in Washington, D.C.

“But we physicians make errors all the time, and we need to discuss them in the open without penalty,” Evans said.

Evans made a distinction between medical errors, adverse events and negligence. Medical errors can be defined as failing to complete a planned action as intended or using the wrong plan to achieve an aim. An example is prescribing penicillin to a penicillin-allergic patient.

An adverse event is an injury caused by medical management rather than by the patient’s underlying disease or condition, while negligence is a legal term indicating a failure to adhere to the standard of care of a reasonable physician in a similar situation. He also revealed some of the reasons why medical errors happen.

“The single greatest cause of errors in health care is the failure to communicate,” said Evans. Good communication requires honesty, openness and mutual respect, but stress and fatigue can contribute to failures in communication.

The top three medical errors family physicians make are failing to properly evaluate and diagnose chest pain, failing to diagnose breast and colon cancer, and making medication mistakes, said Evans.

“The most common mistake is failing to do an adequate evaluation of a patient with chest pain,” he said. “When you evaluate anyone with a complaint that could be related to angina, worry more about that patient and document what you do well.”

Family physicians should ask if the patient’s chest pain is related to exertion, how severe it is, how long he or she has had the pain, and if the pain is increasing in frequency. Admit the patient to a hospital if the pain lasts longer than 20 minutes or the patient has pain at rest for more than 72 hours, Evans said.

“Seventy-five percent of myocardial infarctions and death occur in the first 15 days after pain onset,” he added.

Failure to diagnose breast cancer is the second most common error family physicians make. Evans advised physicians to identify patients with a family history of breast cancer who require mammography screening earlier than conventional screening guidelines require.

“Screen patients with a family history 10 years before the guidelines say,” he cautioned. “Also refer all palpable nodes to a breast-care specialist regardless of mammography findings.”

Medication errors also are widespread, he said. They include failing to prescribe the proper drug, not knowing the best drug to prescribe, and prescribing the wrong dose or wrong delivery system.

Evans advised attendees to use computer aids that can provide instant access to drug interactions and contraindications.

To help avoid errors, physicians also should use a tickler file system as a reminder to contact patients about follow-up exams or tests, sign off on all patients’ lab results, and develop office systems to notify patients of appointments or tests. In addition, physicians should document every notification, said Evans.