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Medical errors and consumer safety
- Pia Maria Jonsson (10 April 2000)
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Pia Maria Jonsson
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Editor - Weingart et al have written an excellent review on the epidemiology of medical error (1). We would like to point out additional ways of addressing patient and consumer safety, both analytically and practically. For healthcare consumers, it is important to avoid not only adverse events related to specific medical errors, but also adverse outcomes where a causal relationship to errors in practice cannot necessarily be established. Clinical decision-making is complicated and often includes an element of "normal" risk taking. The level of risk regarded as acceptable depends on the clinical situation, and may vary from doctor to doctor, patient to patient, and between a patient and his or her doctor (2). Information about the factual risks associated with clinical interventions is a necessary prerequisite for rational decision-making. The possibilities to find facts about the risks of adverse events depend on the features of the healthcare system generating the events. In Sweden, a national Patient Insurance Scheme gives economic compensation to patients who have incured physical or mental injury as a consequence of medical treatment. Compensation is granted regardless of medical responsibility or malpractice. Other Nordic countries have established parallel insurance schemes. Since the Swedish insurance began in the 1970s, more than 100.000 claims have been filed and approximately 40 percent of them have been compensated economically. Data about these cases are available in an extensive numerical database. Although we do not know how large a proportion of all patient injuries are reported to the insurance, this vast database offers possibilities to analyse, eg, injury profiles for different types of healthcare units and the severity of consequences of different types of errors. As opposed to studies of hospital data, the database also permits analyses of outpatient care, comparisons between different levels of care, and studies of trends over time. Previous analyses have addressed, eg, specific types of medical error (3), injuries associated with the use of selected healthcare technologies (4), and gender disparities in the quality of care (5). A more novel approach is to study reports from patients with selected chronic diseases, such as diabetes, and to use the results in informing and educating both practitioners and patients. As the risk of adverse medical outcomes will never fall to zero, the least we can do for consumers is to provide them with available information about the relative safety of their options in everyday health care. Pia Maria Jonsson, Lars Räf, Göran Tomson, References: 1. Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology of medical error. BMJ 2000;320:774-777. 2. Gafni A, Charles C, Whelan T. The physician-patient encounter: the physician as a perfect agent for the patient versus the informed treatment decision-making model. Soc Sci Med 1998;47:355-6. 3. Johansson H, Räf L. A compilation of "diagnostic errors" in Swedish health care. Missed diagnosis is most often a fracture. Lakartidningen 1997;94:3848-50. (Swedish.) 4. Räf L, Claes G. Complications are frequent after surgery for excessive hand sweating. Patients should be informed about the risks. Lakartidningen 1999;96:930-2. (Swedish.) 5. Jonsson PM, Räf L. Is quality of health care for women worse than for men? Two out of three insurance claims concern women. Lakartidningen 1997;94:865-68. (Swedish.) |
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