Talk:Medical error

From Wikipedia, the free encyclopedia

	This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
B	This page has been rated as B-Class on the quality assessment scale
High	This article has been rated as High-importance on the importance assessment scale

	This article is being improved by WikiProject Rational Skepticism. Wikiproject Rational Skepticism seeks to improve the quality of articles dealing with science, pseudosciences, pseudohistory and skepticism. Please feel free to help us improve this page. See Wikipedia:Contributing FAQ.
B	This article has been rated as B-Class on the Project's quality scale. (If you rated the article please give a short summary at comments to explain the ratings and/or to identify the strengths and weaknesses.)
	This article has been marked as needing immediate attention.

	Philosophy Portal This article is within the scope of the WikiProject Philosophy, which collaborates on articles related to philosophy. To participate, you can edit this article or visit the project page for more details.
???	This article has not yet received a rating on the quality scale.
???	This article has not yet received an importance rating on the importance scale.
Additional information: Related task forces (core areas): Ethics

This is the talk page for discussing improvements to the Medical error article.
Please sign and date your posts by typing four tildes (~~~~). Put new text under old text. Click here to start a new topic. New to Wikipedia? Welcome! Ask questions, get answers. This is not a forum for general discussion about the article's subject.	Be polite Assume good faith No personal attacks Be welcoming	Article policies No original research Neutral point of view Verifiability

Useful links (non encyclopaedic) chat at the BMJ

Contents 1 Ballpark figures not very helpful 2 Ball park figures & the Institute of Medicine Report 3 Medical Narcissism 4 Merge proposal 5 adding DID/MPD to see also section 6 Neutrality disputed tag 7 Book section removed 8 Iatrogenesis 9 Medical error vs. mistake?

[edit] Ballpark figures not very helpful

Think of a number and double it? The first sentence of this article is one of the worst I have seen in Wkipedia, namely "In the United States medical error results in 44 000-98 000 unnecessary deaths each year...." What? Doesn't anyone actually have even a reasonable estimate? The 98,000 figure is 222 per cent higher that the 44,000 figure. We are saying that in 1990 (example) there were between 44 000 and 98 000 unnecessary deaths, and in 1981 there were between 44 000 and 98 000 unnecessary deaths. How can we exect Wikipedia to be taken seriously with such ballpark figures. Moriori (Sorry, forgot to sign).

dude. check the ref. Erich 04:20, 12 Jun 2004 (UTC)

There are no exact numbers on this because the numbers I have seen are all estimates based on extrapolations. That's right - the data is not good. And that the data is no good is even more alarming! Kd4ttc 19:19, 12 Jun 2004 (UTC)

I am astonished that User:Erich gasboy, a doctor, would defend a single set of data taken selectively from the tonnes of verbiage available through google. I wonder what he would say if I amended the intro to about 20,000 and gave [1] as the authority. Here's a quote from it -- the Institute of Medicine estimates that over 100,000 patients die every year in U.S. hospitals as a result of medical errors or mistakes…. and beginning in 1999 that dialogue was sold to the American public in newspaper banners and on TV news programs across the nation. However, the important story is that 80% or 80,000 of those 100,000 patients die from an infectious disease. This fact – published by the CDC – was noted in earlier reports in 1999, but seldom mentioned when reported on in recent years. The 80,000 who die from infectious diseases are conveniently ‘bundled in’ with the other 20,000, most of whom did die because of medical errors. I believe our current article is demonstrably lacking in integrity and is doing Wikipedia a great disservice.Moriori 23:59, Jun 12, 2004 (UTC)

Regarding the infections - these are largely preventable deaths themselves. Ventilator associated pneumonia and catheter related infections are examples of infections that are usually caused by poor systems (errors) in place that do not take the necessary steps to prevent such infections. --Jrmunch 04:46, 20 March 2006 (UTC)

Everyone in the hospital dies of an infectious disease. Well, a few die of cardiac arrest, but vastly more die of infectious diseases. A person allergic to penicillin falls and breaks a bone--far from a lethal injury. Goes to hospital, where broken bone is set by orthopaedic surgeon. Suffers anaphylactic reaction to penicillin-class antibiotic because his surgeon forgot to ask about medicine allergies. Gets intubated and sent to the ICU for anaphylaxis. Once in the ICU develops a pneumonia with a multidrug resistant organism. Dies with sepsis 3 days later. Death due to infectious disease or prescribing error? --Matdaddy 01:59, 4 Mar 2005 (UTC)

I prefer to quote peer-reviewed academic journals rather than anonymous web-sources.

Then quote them. You used [2] as a reference for the United States medical error results in 44 000-98 000 unnecessary deaths each year. That reference says no such thing. Moriori

oops that abstract does not give those figure - give me a mo and I'll find and online reference to those stats.Erich 04:34, 13 Jun 2004 (UTC)

Listen, feel free to improve the article if you like. This is a draft article on an important topic. I am a bit stunned by your comments "demonstrably lacking in integrity " and "doing Wikipedia a great disservice". Your reference goes on to clarify that the 80000 infections are also due to error. I've had a look at your contribs to try to understand your perspective, but still stunned really. Anyway if you like please have a look at the quoted refs from the peer-reviewed academic journals and feel free to help us knock of the rough edges of this article. cheers Erich 00:20, 13 Jun 2004 (UTC)

OK, fine. Can you say why a comparison to aviation is relevant?

aviation has an admired saftey culture and often put forward as what health should model itself on. this view does have critics.

The nuclear power industry is also often used as an example of a model of safety. The main point being that these industries have realized that human do make errors, and that the way to prevent them is to use good systems with redundancy that minimize the chance of an error happening or minimize its significance should it happen. --Jrmunch 04:52, 20 March 2006 (UTC)

Should carelessness be added to the section headed "Epidemiology of medical error"?

well that is consistent with the 'blame approach' to error [3]. fatigue, inexperience, overwork, inadequate supervision and lack of training are probably far more common than 'carelessness' though. personally I'm not keen to add carelessness but won't delete it if you add it, as I'm sure as humans we don't maintain 100% care at all times.

What exactly is meant by the following -- while error rates are reduced, the errors just become less likely .

geezz dunno... Steve?

Ideally the likelyhood is so low that the errors are extreemly unlikely?

well 'ideally' agreed. in reality errors happen all the time.

Can I have a go at the encyclopedic nature of this story, and you ensure the efficacy of the medical input? Moriori 01:52, Jun 13, 2004 (UTC)

please do! careful tho - the nuance can be subtle and this is a complex area. I'll work on added a few more refs and try to highlight the ones that it would pay you to look at. (apologies again for the misleading link above).. and if you think I get touchy... you haven't seen Steve stirred up ;-) Erich 04:34, 13 Jun 2004 (UTC)

I have to admit that I agree with person complaining that the avation comparison is irrelevant. What pilot ever jumps on a plane that is already crashing toward the ground, then given the blame when it hits the ground. —Preceding unsigned comment added by 69.221.131.218 (talk • contribs)

Much of the error prevention terminology and early research was developed by the aviation industry. The basic design is the same in aviation and medicine: a complex system with a lot of moving parts, and a human-technology interface. And the consequences of error are death or severe injury. Analytic methods such as root cause analysis and failure mode effects, and concepts such as standardization, process design and team training reduced errors in aviation and are being tried in medical error reduction now. So I think it has a lot to do with it. -- Ryanjo 03:26, 20 June 2006 (UTC)

[edit] Ball park figures & the Institute of Medicine Report

I added a link to the first paragraph of the article (reference #1) for the on-line version of the 2000 Institute of Medicine report, To Err is Human. This report led to the media quoting the 44,000 to 98,000 deaths yearly. As the Executive Summary section report, this was based on two studies (one in Utah and Colorado and one from New York) which were extrapolated to estimate total US mortality by multiplying by the number of hospital admissions. Unfortunately, the links to the references are dead, so we can't examine these studies themselves. (It might be possible to find them elsewhere; I'll try). In any case, the wide range of these estimates derives from the math; two different studies, and amplifying the data to millions of hospitalizations. Not that the point is diminished; a single avoidable death is a tragedy. -- Ryanjo 20:59, 20 June 2006 (UTC)

[edit] Medical Narcissism

I have inserted book by Banya. Medical narcissism is an area that needs to be covered.--Penbat 08:34, 6 October 2006 (UTC)

[edit] Merge proposal

This article should be merged with medical malpractice. Comments? -- FP ^{(talk)(edits)} 10:25, 18 November 2006 (UTC)

Oppose-This article covers the cause and correction of medical error. As I read the medical malpractice article, it covers the legal aspects (mostly). The distinction is useful. I have added a link to this article in medical malpractice, and vice versa. Ryanjo 15:44, 19 November 2006 (UTC)

OK, it looks like there is no interest in merging so I will leave the articles separate. -- FP ^{(talk)(edits)} 04:23, 25 November 2006 (UTC)

Quote from the article: "Humans are notorious for ignoring maintenance schedules and for non-compliance, while airplanes are not". Ahahaha, SO funny. :D 89.155.97.17 (talk) 19:10, 12 March 2008 (UTC)

[edit] adding DID/MPD to see also section

I have added this to the see also section because patients with these diagnosis are often misdiagnosed with other illnesses. ResearchEditor (talk) 02:38, 28 March 2008 (UTC)

See also is for links that attach to or are linked to the entire page. The mis-diagnosis of DID is only one aspect of the condition, and occupies a total of two sentences on the DID page proper. Embed the link in the text as an example if you must. There's no reason to have a single entry in which one, extremely controversial diagnosis (ergo it's arguable that it's medical error to fail to diagnose - if it's not a real condition, it's not a mis-diagnosis) is placed in the see also section as if it were linked in a major way to the entire DID page. Mis-diagnosis is one minor aspect of DID. Also, looking at the lead, the page focusses on unnecessary deaths and injuries. It's unlikely that the misdiagnosis is related handwriting, nurse to patient ratio, poor communication or similarly named medications. Of the examples of errors, the only one that arguably relates to the guts of the page is misdiagnosis, but as even the merck manual says, this may have more to do with skepticism than error. Placing DID in the see also section places undue weight on one aspect of DID. If you can build a section on misdiagnosis of mental illness in general, that would be a very good expansion to the page, as currently it does focus solely on physical conditions and misdiagnosis redirects here. Misdiagnosis does indeed encapsulate far more than just physical treatment errors so it makes sense to expand (or add) a focus on that aspect of medical error but please attempt to expand with more than just DID/MPD. WLU (talk) 18:37, 28 March 2008 (UTC)

Section has been added on misdiagnosis of psychological disorders, which includes information on schizophrenia and bipolar disorder. ResearchEditor (talk) 20:32, 30 March 2008 (UTC)

[edit] Neutrality disputed tag

The article has a "Neutrality disputed" tag from December 2007 which refers to a discusion on this page. I can find no discusion addressing this tag. And so will soon remove the tag as it appears not to be a current concern. others? SmithBlue (talk) 07:06, 26 April 2008 (UTC)

Agree, remove tag. Ryanjo (talk) 19:36, 27 April 2008 (UTC)

Neutrality tags have been removed. ResearchEditor (talk) 02:12, 9 May 2008 (UTC)

[edit] Book section removed

I am wondering why the entire book section was recently removed.

• Gawande, Atul. Complications: A Surgeon's Notes on an Imperfect Science. New York, NY: Metropolitan Books; 2002.

 

• Wachter, Robert and Shojania, Kaveh. Internal Bleeding: The Truth Behind America's Terrifying Edidemic of Medical Mistakes. New York, NY: Rugged Land; 2004.

 

• Banja, John Medical Errors and Medical Narcissism, 2005

 

• Porter, Michael E. and Olmsted Teisberg, Elizabeth Redefining Health Care: Creating Value-Based Competition on Results, 2006 ResearchEditor (talk) 02:12, 9 May 2008 (UTC)

I have restored this section temporarily. If there was a reason for its deletion, please cite here. ResearchEditor (talk) 03:40, 13 May 2008 (UTC)

The book section definitely belongs Smallbones (talk) 15:49, 13 May 2008 (UTC)

[edit] Iatrogenesis

I put the iatrogenesis link in the article. Unlike Medical malpractice I think there is a case for a merger between the 2 articles. I won't make or push that case however. FWIW, TIME Magazine quotes 90,000 annual US deaths from medical error in the article [[4]] on Peter Pronovost as one of the 100 most influential people in the world - No wikipedia article on him?! I have checked the spelling. Smallbones (talk) 15:49, 13 May 2008 (UTC)

[edit] Medical error vs. mistake?

Hello, I will soon sit in front of an inquiry commission on diagnostic errors in Pathology and have been thinking a lot about this. In the mind of a pathologist, an error is not synonymous with a mistake. Here is how I see it:

• Mistake: avoidable, results from misjudgement, inattention or negligence. Given a second chance, the person will not repeat his mistake. Example: administering a drug to the wrong patient.
• Error: unavoidable, results from the limits of scientific tools. Given a second chance, the professional will most likely repeat his error. Example: a negative HIV blood test in a patient with advanced AIDS (a well known limitation of this diagnostic test) causing a delay in his diagnosis and treatment.

This difference is very important when a professional is facing disciplinary action. Yet, it is not understood by most and is not clearly spelled out in dictionaries. What do you think? Can you find a reliable source explaining this? Emmanuelm (talk) 14:35, 30 May 2008 (UTC)

IMHO, the terms are synonymous, i.e. "I made an error" and "I made a mistake". Don't get caught up in the words; your examples call attention to the process. In the first example, the analysis was faulty ("human error"). In the second, information was false negative ("process error"). Most medical errors resulting in an adverse result are thought to be initiated by an human error (ie: not considering HIV, since a test is negative). This is allowed to occur, or not caught and corrected, by a flawed process (ie: lab does not suggest to clinician a repeat or confirmatory test).[5]

Your concept that human error is inevitable has a lot of support. In the conclusion of the analysis of the causes of adverse events from the Quality in Australian Health Care Study, the authors state:

Our study emphasises the need for designing safer systems for care which protect the patient from the inevitability of human error. These systems should provide new policies and protocols and technological support to aid the cognitive activities of clinicians.[6]

Regrettably, most inquiries are structured to lay blame on the individual, not to investigate the failed process that didn't correct the predictable human error.

Good luck. Ryanjo (talk) 19:20, 31 May 2008 (UTC)

Thank you Ryanjo, you are unfortunately right.

I'd like to clarify one point about the false-negative HIV blood test: this test detects antibodies against the HIV virus. AIDS causes immune deficiency, hence lower antibodies, including antibodies against the HIV virus. No matter how often you will repeat this test, it will be negative in these patients. Therefore, the lab made no error but the doctor might miss the diagnosis based on this lab test. Since laboratories suggest a confirmatory test only for positive tests, this false-negative can only be caught by the physician who saw the patient. Emmanuelm (talk) 01:26, 1 June 2008 (UTC)