U.S. medical system creates errors

United Press International

By PEGGY PECK, United Press International

Tuesday, May 4, 2004


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.

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Peggy Peck covers medical research and health issues for UPI Science
News. E-mail sciencemail@...