Most doctors agree that medical errors should be reported to their hospitals, but a significant number admit they don’t always report their own, a University of Iowa study shows.
Researchers surveyed 338 physicians at three unidentified teaching hospitals around the country. Seventeen percent of the doctors admitted anonymously that they had failed to report minor errors, defined as mistakes that “prolonged treatment or caused discomfort.” Four percent admitted they had failed to report mistakes that “caused disability or death.”
The researchers, led by U of I medical-ethics professor Lauris Kaldjian, published the survey results Monday in the Archives of Internal Medicine.
Besides being asked about their own records, the physicians were asked whether they would report a hypothetical situation involving a medical error: A doctor prescribes an antibiotic to a 67-year-old pneumonia patient whose medical chart says he is allergic to the drug.
Forty-three percent of the doctors said they would likely or very likely report the incident if no apparent harm came from the mistake. Seventy-three percent said they would report it if the man suffered a temporary rash because of the mistake. Ninety-two percent said they would report it if the man suffered breathing problems and a heart attack.
Kaldjian said in an interview that he was encouraged that most of the doctors believed reporting errors was an important way to improve health care quality. But he said he was troubled by the fact that fewer than half of them would have reported the hypothetical error if it didn’t cause problems. He said doctors and other medical workers should take their cue from the airline industry, which encourages pilots to report every error so it can be analyzed for possible systemic flaws.
The researchers noted several limitations to their work. The survey was done in 2004 and 2005, and may not reflect recent emphasis on reporting errors, they said. And the survey was limited to doctors specializing in family medicine, internal medicine and pediatrics.
Kaldjian also noted that only 36 percent of the doctors admitted ever making a mistake, and he said he was skeptical of that figure. “I have a hard time believing either a resident or an attending physician never made even a minor error,” he said.
The professor said he was surprised to find that physicians who have been sued were as likely as their peers to say they would report errors. He hesitated to make too much of that finding, because the sample size was relatively small, but he said it was interesting.
“My intuition would have said that once one was stung by a lawsuit, it would be more difficult to talk about errors with anyone,” he said.
A Des Moines physician who studies ways to improve safety said he found several positive things in Kaldjian’s study. Tom Evans, president of the Iowa Healthcare Collaborative, said few doctors saw medical errors as a major problem when he started practicing medicine in 1983. The survey clearly shows those attitudes have changed, he said. “I’m encouraged by the traction this shows,” he said. “Doctors are getting it.”
Evans noted that industry leaders have talked a lot recently about the need to cut down on medical errors. He said he suspects the survey results would have been better if they were more current. “I’d love to see this measured over time, to see if we’re on track,” he said.
Although the study did not identify the three teaching hospitals whose doctors were surveyed, it says they were in the Midwest, Northeast and mid-Atlantic regions of the country. It also lists contributing authors at the University of Iowa, Yale University and Penn State University. Kaldjian declined to comment on whether those schools had the three hospitals in question.
For more information on this subject, please refer to the section on Medical Malpractice and Negligent Care.