The magnitude of medical errors in the clinical setting is staggering. The landmark 1999 Institute of Medicine (IOM) report To Err is Human: Building a Safer Health System concluded that “as many as 98,000 people die in hospitals each year as a result of medical errors that could have been prevented.” That IOM report accelerated the patient safety movement at both the federal and state levels.
More than a decade and a half later, the estimated number of deaths due to medical errors remains unacceptably high. According to a recent study by Johns Hopkins University School of Medicine published on May 3, 2016 in the British Medical Journal, medical errors may be the third leading cause of death in America. After reviewing the scientific literature and peer-review research, the patient safety researchers from Johns Hopkins estimated that the number of deaths in America due to preventable medical error exceeds 250,000 deaths per year.
Full disclosure as policy
In 1987, long before the 1999 IOM report, the Veterans Affairs Medical Center (VAMC) in Lexington, Kentucky instituted a then-controversial program of disclosing medical errors and apologizing and compensating patients for them. Apart from the ethical and moral rationale for transparency and full disclosure, the VAMC believed that a policy of extreme honesty or full disclosure might reduce malpractice claims. Twelve years after the VAMC instituted its policy, it reported that hospital administration and staff supported it and, counterintuitively, it yielded unanticipated financial results.
The “Blame and Shame” game
For too long, our society has put blame and shame on the nurse or physician who was believed (often unfairly) to have caused a medical error. Apart from the devastating effects that blaming a health care practitioner can have (e.g., possible loss of a job, adverse actions by a State licensing board, collateral civil litigation, and negative reputation among peers), such an ill-conceived approach tends to understandably result in under-reporting. What is the incentive for a physician or nurse to admit and error if it will result in all manner of punishment and potentially catastrophic professional damage?