Medical Mistakes

Medical mistakes, or medical errors as they are called in research literature, are terms that defy easy definitions. In a widely cited report on adverse medical outcomes titled To Err Is Human: Building a Safer Health System, Kohn, Corrigan, and Donaldson of the Institute of Medicine (IOM) define medical error as the failure to achieve an intended goal either because of a failed initiative or a plan of action that is ill conceived.

This means that errors can occur in execution, in planning, and at all stages of practitioner-patient interaction. There is a wide range of medical errors, including failure to diagnose, misdiagnosis, and late diagnosis; drug prescription and administration errors, and failure to foresee adverse reactions among multiple prescriptions; over-, under-, and misprescribing of medications; surgical and procedural errors; overuse of diagnostic tests and surgical procedures, such as Caesarian sections; mistakes in choice of intravenous (IV) solutions, their concentrations, and drip rates; mishandling of medical records and test results; and failure of aseptic procedures resulting in spread of infections in hospitals. However, it is important to be mindful that injuries, such as surgical cuts and adverse outcomes, such as medication side effects, are expected to have a certain occurrence. In risk assessments, as long as a treatment does more good than harm, a rate of occurrence of side effects is deemed acceptable. However, if an unusual injury or adverse outcome occurs where a risk assessment is unclear, regardless of whether it was preventable or due to practitioner negligence, the event may appear as error. Thus, studies of medical errors often define them as adverse events that could have been prevented.

The complexities of the previous definitions reveal that identifying medical error is itself fraught with potential error. With injury being a normal part of surgery, and treatment often incurring side effects, distinguishing normality from error is difficult. The IOM report describes in detail the multidimensional nature of errors and the challenges of identifying and preventing them. In fact, the IOM report's main impetus is a call to apply to medical settings the standard safety and risk management practices found in other industries that place people at risk, such as the airline industry. The emphasis is on safety and the prevention of adverse events through systemic changes in organizational procedures and professional culture. If an adverse event can be avoided, whether or not the treatment process included errors is a moot issue.

However, the practice of medicine is distinct from other industries. Medical care is about trying to save people as well as keeping them safe. For example, in hospital care even the extreme outcome of death is normal. In contrast, in most other industries, even those that are risky such as airlines and mining, there is no justification for a death. Error and risk assessments in medical care delivery occur in the context of biomedical complexity, esoteric knowledge, and the resulting uncertainty of medical practice. Notwithstanding periodic fluctuations in occupational prestige, medical practice has professional components that make it distinct from industrial work. Medical practitioners are allowed a degree of professional autonomy that overrules and sometimes conflicts with the formal rationality of typical production bureaucracies. This means that what constitutes error depends on what constitutes standard procedures, but many such procedures are necessarily elastic. Medical practice standards are normative. They depend, at a particular time in history, on a society's level of medical and organizational knowledge, its resources, and its epidemiology, including socially produced mortality and morbidity.

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