“Bad Apple” Doctors and Nurses, or Negligent Systems — What Causes Medical Error?
In 1999, a study by the Institute of Medicine estimated that 44,000 to 98,000 Americans die every year from medical error. Later, in 2013, a study by Johns Hopkins patient safety experts put the number at more than 250,000 deaths per year.
Since the 1999 study, medical schools, governments, healthcare, and patient-advocacy groups have asked what causes medical error, and focused in on the issue of patient safety. Two decades of study lead to this big-picture conclusion: Medical errors flow mostly from badly designed systems — not from bad physicians and nurses.
Of course, physicians and nurses are human, so naturally there are some bad ones. But not enough to make medical error a major cause of death and disability. The bulk of the problem comes from putting ordinary physicians and nurses into bad systems.
What causes medical error? Hospitals, physician practice groups, and other healthcare organizations containing a wide variety of system failings. Many system failings fall into some broad categories:
- Failure to document important information, so that providers later don’t have the information.
- Failure to communicate more generally.
- Making decisions off the cuff, when multiple factors need to be considered and some can easily be ignored if the provider doesn’t consult a simple checklist.
- Failure to train and support individual providers.
- Overworked providers.
- A culture that does not encourage speaking up about patient care problems and does not acknowledge and learn from medical errors.
If (or more likely when) you find yourself or a loved one in a hospital, keep an eye on what’s happening. Talk to the nurses and doctors. Make sure they know what’s happening with their patient. Ask questions. If you see things being neglected, raise the issue politely but firmly.
When we or a loved one is sick and in the care of medical providers, we feel vulnerable. We naturally trust the providers and feel inadequate to challenge their decisions. To some extent, that makes sense: A physician or nurse do know more than we do. It’s hard to know a mistake when we see it. And it won’t help to get pushy or rude: That will make things worse, not better.
On the other hand, it is not realistic to assume we will routinely get good care.
So, what can we do? Again, pay attention, keep nurses and physicians informed, and ask questions. If you have concerns that you don’t think are being addressed appropriately, talk to connections with medical knowledge (if you have any). Talk to a case manager or patient liaison at the hospital. Go up the chain of command. Seek a transfer to another hospital.
Ultimately there is no perfect solution, but your chances, or your loved one’s, will improve with attention, communication, and questions.