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Medical massacre
By: Leader
The Guardian, March 5, 2001
Admitting error is the first step to reform.
Twenty-five years after Ivan Illich first highlighted the problem in the United States, the first hospital-based study measuring medical mistakes in this country has been published in the British Medical Journal (BMJ). In Medical Nemesis, a philippic against doctors, Illich used statistics on American medical error to suggest hospitals were more dangerous than all industrial sites except mines and high-rise construction. The BMJ study, based on two London hospitals, estimated one in ten admissions suffers some form of harm. With 8.5m hospital admissions a year, this confirms an estimate made by a working party for the chief medical officer last year which suggested there are 850,000 "adverse incidents" in the NHS every year.
The study said that in one-third of cases there was serious harm and in 8% the error contributed to the patient's death. Extrapolated these figures suggest medical errors in NHS hospitals in England contribute to 68,000 patient deaths and 200,000 permanent or moderate injuries. In the same issue of the BMJ, Sir George Alberti, president of the Royal College of Physicians, said that although it was only based on 1,000 case records "there is no reason to believe the results are unrepresentative". Can the medical profession, already reeling from scandals in Bristol, Liverpool and Kent, take any more punishment? Ironically, this study ought to help not harm. It coincides with a new push by the medical establishment, including the chief medical officer, the British Medical Association and the royal colleges, to move to a more open system of reporting error. Like other professions, medicine has been in the grip of a "blame culture" that has deterred people from reporting error. Worse, medicine has helped perpetuate the myth that doctors never make mistakes, which has reinforced reluctance to report adverse events.
The good news about errors is that about half are preventable. One ambition is to copy the aviation industry, which by encouraging the reporting of errors by pilots and air traffic controllers, systematically studies "near misses" to reduce risk and make air travel safer. George Alberti wants a national study of NHS error. But we do not need to wait. The road to remedy is now clear. Last June the health secretary promised an open reporting system by the end of 2000. He has not yet delivered and needs to correct his error.
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