Intended for healthcare professionals


Reducing error, improving safety

BMJ 2000; 321 doi: (Published 19 August 2000) Cite this as: BMJ 2000;321:505

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Defensive culture of British medicine needs to change

  1. Victor Barley, consultant oncologist,
  2. Graham Neale, retired physician,
  3. Christopher Burns-Cox, consultant physician,
  4. Paul Savage, retired surgeon,
  5. Sam Machin, professor of haematology,
  6. Adel El-Sobky, consultant psychiatrist,
  7. Anne Savage, retired general practitioner
  1. Bristol Oncology Centre, Bristol BS2 8ED
  2. London SW17 7BB
  3. Wotton-under-Edge, Gloucestershire GL12 7PB
  4. London NW3 5RA
  5. Department of Haematology, University College Hospital, London WC1E 6AU
  6. Hepscott, Northumberland NE61 6LB
  7. c/o Action for Victims of Medical Accidents, 44 High Street, Croydon CR0 1YB
  8. Department of Primary Health Care and General Practice, Imperial College of Science, Technology and Medicine, London W2 1PG
  9. Darlington Memorial Hospital, Darlington DL3 6HX
  10. Karolinska Institute, Department of Public Health Sciences, S-171 76 Stockholm, Sweden
  11. Swedish Patient Insurance Fund, PSR, Box 17830, S-118 94 Stockholm, Sweden
  12. Department of Surgery (Queen's University, Belfast), Institute of Clinical Science, Belfast BT12 6BA
  13. Auckland University of Technology, Private Bag 92006, Auckland 1020, Auckland, New Zealand
  14. Patient Concern, PO Box 23732, London SW5 9FY
  15. Clinical Information and Support Office—Support Building, University Health Systems, Greenville, NC 27835-6028, USA
  16. Brody School of Medicine at East Carolina University, Greenville, NC 27858, USA
  17. St John's Hospital at Howden, Livingston, West Lothian EH54 6PP
  18. University of Salford, Frederick Road Campus, Salford M5 4WT
  19. Institute of Medicine, Law and Bioethics at the Universities of Liverpool and Manchester, University of Manchester, Manchester M13 9PL
  20. Human Factors Research Group, Faculty of Education, University of Manchester, Manchester M13 9PT
  21. Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN
  22. Royal College of Anaesthetists, London WC1B 4JY
  23. Standards Committee, Association of Anaesthetists of Great Britain and Ireland, London WC1B 3RA
  24. Spectrum Health-East Campus, Grand Rapids, MI 49506, USA

    EDITOR—It was brave to devote a whole issue to medical error1—how to recognise, how to investigate, how to analyse, and how to change systems to improve patient safety.1 However, we regret that the edition was dominated by American studies, ignoring the British contribution of confidential inquiries and analyses of closed claims, which have significantly improved safety in some well defined areas of medical practice.

    In the United States the insurance industry provided the impetus for the study of adverse events,2 and in Australia the government funded a similar study3 because it was considering “no fault” compensation.3 In the United Kingdom, for 25 years the Department of Health has financed all successful claims against NHS hospitals and their staff. As a result the need to take a British study beyond the pilot phase may not be supported.4

    Be that as it may, an important issue was not addressed in the BMJ. Behind each adverse event there is a patient, a doctor, and a doctor-patient relationship. A patient must be told when things have gone wrong. Every effort must be made to minimise the after effects, including financial compensation where necessary. Most patients wish to know in detail what happened and what is being done to reduce the possibility of a recurrence. And members of healthcare teams need mechanisms to come to terms with their fallibility. It is to be hoped that clinical governance will make a difference.

    Meanwhile a change in the ethos of medical practice is required, and it is to this end that Action for Victims of Medical Accidents has set up a group for doctors. Action for Victims of Medical Accidents is often regarded as dealing solely with compensation and litigation, but its raison d'être has always been to improve …

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