Mistakes

Every professional knows that they make regular mistakes but most professionals usually attempt to minimise them. The medical professions (human and veterinary) are no exception. The UK media sensationalises medical mishaps, creating an impression for the public that mistakes are uncommon and catastrophic. This is incorrect. Consider perhaps, how the media reports motorway speeding. Motorway speeding is constantly occurring throughout the UK and it can be dangerous, but it doesn't generally make the news, unless perhaps there's a police chase at 150mph or some other similar event. The same principle applies to reporting medical mishaps because only occasionally do cases become newsworthy. Medical mishaps however, remain commonplace.

To illustrate the point, the following incidents were observed from treatments at the same hospital involving relatives and friends of a single, casual observer.

[1] A female hospital patient was admitted for an upper respiratory tract infection and suffered a head of femur (hip) fracture during her stay in hospital.

[2] The patient cited in [1] above subsequently suffered a distal radius (wrist) fracture during the same stay in hospital.

[3] The patient cited in [1] above had not received analgesics (pain relief) for about 45 minutes after complaining of severe hip pain following her fall in hospital. Hospital nursing staff were observed laughing in response to loud cries of discomfort from the patient.

[3] A female patient treated for hyperthyroidism was offered a thyroidectomy (surgical removal of the thyroid) on multiple occasions. The offers were declined when second opinions were sought. The hyperthroidism was subsequently controlled by medicants (drugs).

[4] A female patient was offered metoclopramide on multiple occasions despite recent incidents of obstipation.

[5] A female post-menopausal patient was advised to receive a Mirena under general anaesthetic.

[6] A female patient admitted for surgical treatment of varicose veins suffered a post-operative embolism. She did not survive.

[7] A female patient cited in [3] above post-operatively suffered exacerbated Alzheimer's Disease, which proved fatal.

The observer of the above incidents perceived the treating hospital to be a good one. The rationale behind the conclusion was that medical mishaps are common, and medical practitioners endeavour to perform well despite the common mistakes.

Findings in the literature support the premise that mistakes are common, and in fact have continued to be commonplace for some time (Health Grades, 2015; Hunt, 2013; Beckford, 2013; Independent, 2012; BMJ, 2001; BBC News, 2000). However, how efficient are the current measures employed to minimise mistakes? Any system that encourages medical professionals to report the failings of colleagues will remain unpopular. If such reporting was to become popular it would foster mistrust within the medical professions and reduce cooperation between colleagues: such a situation would significantly endanger patients. The same rationale applies to encouraging patients (or patients' owners) to report perceived failings of medical practitioners. Such reporting would increase the monitoring of medical professionals. However, the resultant mistrust and heightened levels of stress would in turn elevate the number of mistakes made, rather than reducing them. The veterinary and human medical professions already demonstrate the highest suicide rates of any UK professions, and increasing stress loads further would only serve to endanger patients.

Nevertheless, is monitoring per se a bad thing? Not necessarily. Returning to the previous motoring example, although motorway speed cameras can generally spoil the driving experience, they do decrease vehicle speeds. How then can monitoring be employed to improve medical practice rather than damaging it?

Subjectively, the answer lies in the rationale behind the monitoring. Most professionals appreciate colleagues checking their work for overlooked mistakes, but few appreciate monitoring that is used to impose punitive action. Fostering a culture of cooperation and quality control is a win-win approach for both practitioners and patients alike. Conversely, setting colleagues against each other, or patients against practitioners is usually politically motivated and results in a lose-lose scenario for both patients and the medical profession(s).

REFERENCES

Right Diagnosis (2015). How Common Are Medical Mistakes? Health Grades, 4th June 2015.
http://www.rightdiagnosis.com/mistakes/common.htm

Jeremy Hunt (2013). NHS errors mean eight patients die a day. The Guardian, Friday 21st June 2013.
http://www.theguardian.com/politics/2013/jun/21/jeremy-hunt-nhs-errors-patients

N. Beckford (2013). Hospitals reveal 750 'should never happen' blunders. BBC News, 9 May 2013.
http://www.bbc.co.uk/news/health-22366147

Doctors' basic errors are killing 1,000 patients a month (2012). The Independent, Thursday 04 June 2015.
http://www.independent.co.uk/life-style/health-and-families/health-news/doctors-basic-errors-are-killing-1000-patients-a-month-7939674.html

Medical errors: a common problem (2001). British Medical Journal, 322:501.
BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7285.501 (Published 03 March 2001)

Medical errors 'kill thousands' (2000). BBC News, Saturday, 18 March, 2000.
http://news.bbc.co.uk/1/hi/uk/682000.stm