New York Medical College Department of Family Medicine

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Patient Safety and Medical Errors

Family Medicine ClerkshipNew York Medical College2003 – 2004

Joseph L. Halbach, MD, MPH

New York Medical College Department of Family Medicine

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Patient Safety and Medical Errors

Today’s Discussion Errors/Mistakes in general Responses to mistakes One brief description of a medical error What responsible physicians experience

after an error Brief data on medical errors What’s the problem What to do as a medical student

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Patient Safety and Medical Errors

Non-Medical Mistake Think about a recent error or mistake

that you made. What was your reaction to making that

mistake?

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“Jose Martinez”fromThe New York Times Magazine

Patient Safety and Medical Errors

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“The emotional impact of mistakes on family physicians.” Newman 1996

30 family physicians interviewed by a family physician.• Memorable mistake• Response to a hypothetical scenario in which a

colleague’s decision was associated with a fatal outcome

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24/30 30-50 years old26/30 male26/30 married27/30 white

23/30 remembered a mistake

5/30 unable to remember a mistake

2/30 had never made a mistake

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Memorable mistake 18/23 family physicians who

remembered making a mistake made their most memorable mistake post residency

Remembered mistakes occurred almost as often in their offices as in the hospital.

Patient Safety and Medical Errors

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Reactions96% reported self doubt93% were disappointed in

themselves86% blamed themselves for the

mistake54% experienced shame 50% experienced fear

Patient Safety and Medical Errors

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Support? In response to their mistakes, all but one

physician stated a need for support.• 63% needed to talk to someone• 48% needed validation of their decision

making process• 59% needed reaffirmation of their

professional competency• 30% needed reassurance of self worth

Patient Safety and Medical Errors

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Source of support?

55% spouse33% colleague

Patient Safety and Medical Errors

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Hypothetical scenario A colleague of yours recently saw a 54-year-old man in his

office who was complaining of burning epigastric and lower retrosternal chest pain without radiation or other associated symptoms about an hour after lunch. In the office, the EKG showed some unifocal PVCs and some non-specific ST-T wave changes. After evaluating his patient’s condition, your colleague recommended that he take an antacid and return to the office in one week. Later that night, the patient was taken to the ER, unconscious, in V fib. The following morning, word has gotten around about how this attending physician missed an obvious and fatal MI. On making rounds, you see your colleague at the nurse’s station.

Patient Safety and Medical Errors

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All but one family physician thought that their colleague needed support.

Nine (32%) would have offered support unconditionally

19 (68%) would have offered support if:He/she were a close friend or partnerHe/she first solicited their support

Patient Safety and Medical Errors

New York Medical College Department of Family Medicine

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Epidemiology of medical errorsIncomplete picture

• 1984 Harvard Medical Practice study• 1999 Colorado/Utah study• 1999 report of the Institute of Medicine

To Err Is Human

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IOM reports 44,000-98,000 Americans die in hospitals each year as a result of medical errors.

8th leading cause of death (surpassing MVAs, breast cancer, AIDS).

6% of national health care expenditures (1996).

7000 deaths from medication errors alone (1993).

Patient Safety and Medical Errors

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What’s the PROBLEM(S)?(e.g., in the Jose Martinez case)

Patient Safety and Medical Errors

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What would help to PREVENT ERRORS?

Are there any RULES/REGULATIONS about what we should do/have to do?

Patient Safety and Medical Errors

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What to do as a medical student?

- M and M on the Webwww/webmm.ahrq.gov

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New York Medical College Department of Family Medicine

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New York Medical College Department of Family Medicine

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New York Medical College Department of Family Medicine

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What to do as a medical student:JCAHO National Patient Safety Goals

#1 Patient Identification #2 Abbreviations#3 Wrong site, wrong patient,

wrong procedure

Patient Safety and Medical Errors

New York Medical College Department of Family Medicine

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Summary

Patient Safety and Medical Errors

Mistakes happen to everyone.Good doctors make bad mistakes.When we make an error, we need support.Most errors result from system problems.Open reporting and disclosure, not

“shame and blame”.Stayed informed!