Editorial: Have you joined the patient safety movement?

January 1, 2006

It seems that "patient safety" initiatives are abuzz at every hospital and medical school I visit. Medical errors are much too common. It's time for that to change.

Results of a national survey of physicians published just 4 years ago showed that only 5% rated medical errors as one of the most serious problems facing the health-care system.1 Yet 35% of those polled had experienced an error in their own or a family member's health care and 18% of the physicians acknowledged that such errors caused death, disability, or severe pain. Even more surprising to me was that 86% of the physicians surveyed thought medical errors should be kept confidential, as opposed to admitting the need for improvement in patient safety. And worse yet, a more recent study shows that more than 90% of physicians report deviating from sound medical practices to lower their risk-but of being sued, not of committing an error.2

Among ob/gyns, the most common defensive tactics are ordering more diagnostic tests, prescribing more medications, making unnecessary referrals to other specialists, and avoiding certain procedures. Ironically, those behaviors actually heighten the risk of a lawsuit by making it more likely that abnormal lab test results will be missed or medication errors will occur. Studdert and associates contend that widespread use of practices like those I've listed also unintentionally raises the bar for the definition of standard of care, which also can increase your chances of being sued.2

Diagnostic and treatment issues contribute to 18% and 31% of adverse ob/gyn outcomes, respectively, and problems here generally relate to an individual provider's medical decision-making or technical skills.3 This speaks to the lack of adequate protocols, periodic "time-outs" to confirm pertinent clinical findings and adherence to ACOG guidelines or institutional policies, and lastly, physician back-up. The latter may take the form of advice on medical or obstetrical decision-making or an expert pair of hands in the DR or OR.