La Leva di Archimede (ENG): Death By Medicine: U.S. medical system creates errors

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Death By Medicine: U.S. medical system creates errors

U.S. medical system creates errors

United Press International

By PEGGY PECK, United Press International

Tuesday, May 4, 2004

Source: MedlinePlus

 

PHILADELPHIA, May 04, 2004 (United Press International via COMTEX) -- American

doctors write about 3.5 billion prescriptions every year and new research

suggests nearly one in every 100 of those prescriptions is wrong -- the wrong

drug, the wrong dose or the wrong patient.

 

Of 28 million erroneous prescriptions written annually in the United States,

most contain minor errors that do not hurt patients. But about 21 percent --

nearly 6 million -- contain " serious errors, " according to Dr. Lucien Leape, an

adjunct professor of health policy at the Harvard School of Public Health in

Cambridge, Mass., who is considered the world's leading expert on medical

errors.

Leape told a packed audience at the opening session of the American College of

Obstetricians and Gynecologists meeting that he estimated those prescription

error rates based on a study of office-based physicians.

 

Later, Leape told United Press International that his new study, which currently

is being reviewed by a medical journal, uses data collected from four physician

groups practicing in the Boston area. He said he thinks the error rate is the

same at doctors' offices around the country because the U.S. medical system is

designed in a way that promotes errors.

 

For instance, Leape noted that although training programs have been overhauled

recently to cut down on the number of hours medical residents are on call,

" there are no such limits on the hours of attending physicians. " Thus, he said,

senior physicians can be subject to same lack of sleep that threatens medical

judgments in young doctors -- yet no one is policing the older doctors' work

hours. In fact, a practice built on long hours commonly is considered the

medical model.

 

Leape cited a medical practice in the Boston area that comprises 13 orthopedic

surgeons.

 

" They decided to cover weekends by having one surgeon cover every 13 weeks,

which sounds really good to surgeons who are used to covering every other

weekend, " he said. But this practice also defined weekends as Friday afternoon

through Monday morning, " or roughly about 70 hours on call. "

 

One weekend, Leape said, the covering physician performed 34 operations, a

workload he said was likely to have impaired that surgeon's judgment and skill

by the end of the weekend.

 

In the past, he said, medicine was " simple, relatively safe and ineffective. But

today medicine is complicated -- we regularly perform miracles -- which has made

it less safe, and it is still ineffective. " The problem, he explained, is

doctors continue to be trained to think by themselves and for themselves, rather

than being team players.

 

Leape said the patient safety movement continues to struggle to gain momentum

and he praised the obstetrician-gynecologist group for highlighting patient

safety at its meeting, a move that set " ACOG apart from other professional

societies, " where patient safety is not considered an appropriate agenda item.

 

But physicians, nurses and other medical staff are not the only players needed

to improve patient safety said Dr. Carolyn M. Clancy, director of the federal

government's Agency for Healthcare Research and Quality in Washington, D.C.,

which tests the efficacy of different treatments and develops guidelines for

good medical care. Clancy told UPI that " patients need to become participants in

the patient safety movement. "

 

For example, she said, patients can reduce the chance of receiving an erroneous

prescription if they " arrive at the doctor's office with all the needed

information, which includes a complete list of medications and a good knowledge

of their medical history. "

 

Using the example of people with diabetes, Clancy said her agency has determined

most diabetic patients do not receive the proper medical care, including the

needed checkups with attention to special concerns, such as kidney function and

eye health. " But the diabetic patients know that they need this treatment, so

they have some responsibility here, too, " she said.

 

Dr. Benjamin Sachs, obstetrician-gynecologist-in-chief at Beth Israel Deaconess

Hospital in Boston and a professor at Harvard Medical School, is another

proponent of team-based care.

 

Sachs told UPI he is conducting a study to determine if team-based medicine -- a

plan in which junior staff such as residents and nurses can question the

decisions of senior physicians -- could reduce medical errors and if reducing

the error rate could translate into cost savings.

 

Although he cautions that the data are preliminary, he said 43 percent of

medical malpractice claims at his hospital could have been prevented or

mitigated by initiating a team approach. Moreover, he said, already the new

cooperative approach has reduced medical errors at his hospital, which has been

rewarded with a 10 percent reduction in malpractice insurance premiums.

 

A reduction in malpractice premiums is good news, Leape said, but he cautioned

against equating medical malpractice insurance gains with gains in patient

safety.

 

" The tort system does not improve patient safety because it is all about blaming

the individual, " he said. For that reason, he supports no-fault insurance to

cover medical injury rather than reforming the system by putting limits on the

ability to sue or on the amount of money paid out in damages.

 

--

 

Peggy Peck covers medical research and health issues for UPI Science News.

E-mail sciencemail

 

 

Copyright 2004 by United Press International.

 

 

 

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