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Medical injuries incurred by patients while in hospital result in longer
hospital stays, increased hospital charges, and more than 30 000 deaths
each year in US (1). Adverse events and medical errors affecting patient
care are recognized internationally as major problems in medicine. The
failure of health care professionals and health institutes to address this
problem has threatened to undermine public confidence in the health care
system as a whole (2). There were 15,003, medical malpractices reported at
the Japan’s 82 special-function hospitals which involved 387 patient
deaths or other serious injuries, according to a Health Ministry survey
report released recently. The report further reveals that there were
186,000 cases in which accidents nearly occurred. The performance of
Japanese doctors has come under scrutiny after a series of embarrassing
and tragic mistakes (3).
According to the Doctor's Act in Japan, doctors must report cases of
unusual death to the police. However, in Japan, medical accidents are
rarely reported nor autopsied (roughly 4•3% overall autopsy rate). In UK
medical accidents and other unusual deaths are frequently autopsied
(overall rate 24%) (4).
Little is known about the Japanese malpractice environment because claim
information has been closely guarded. The lack of data on all claims
hinders adequate evaluation of dispute resolution methods, development of
appropriate risk management activities, and proactive education for
Japanese physicians (5).
It is necessary to create at least now a environment of “culture of
openness” in which errors are reported and then dissected to reveal
underlying causes so that future mistakes can be prevented. A profound
change in the culture surrounding medical error that is shifting the
emphasis from silence to safety is required for achieve overall patient
safety (6). In the past decade, Japanese researchers have conducted
various clinical studies in regard to ethical problems in clinical
settings. These studies have revealed that truth telling is not regarded
as a standard aspect of care in Japan (7).
A very good program was highlighted by the international medical
community, which was in operation in Australia called “Privileged
disclosure of medical errors”. Through the Australian Incident Monitoring
Study (AIMS), health care workers in many states are voluntarily and
anonymously reporting incidents and accidents.
This “culture of safety” is
essential to allay public health community fears and reprisals not only in
Japan but also in other countries as well.
A recent media article “Greater accountability for malpractice sought” it
was highlighted the crucial issues about increasing medical malpractices
in Japan and government intended proposed prevention programme by revising
the Medical service law. Action to reduce clinical risk should not include
punitive actions against the people who make the mistakes, but rather
action on the systems in which the mistake occurred. In the complex
environment of acute health, it is very common and surprisingly simple for
medical errors to occur. The health care system is significantly behind
other high-risk industries in its attention to ensure basic safety (8).
The key behind reducing clinical errors is to make it difficult to do the
wrong thing, and easy to do the right thing. A public health approach
requires medical community and organizations to participate in a
coordinated effort to understand the nature and extent of medically
induced injuries through a sophisticated surveillance system and to
establish systematic prevention strategies.
References:
(1).Mayor S., Medical injuries in US hospitals cause more than 30 000
deaths each year BMJ 2003; 327:887
(2).Herbert, P.C., Adverse disclosure of adverse events and errors in
health care: an ethical perspective. Drug Saf. 2001; 24:1095-104
(3).Watts, J., Are Japan’s medical sensei losing the public’s
respect? Lancet 2000; 355: 994-995.
(4). Ken-ichi Yoshida, K., Kuroki, H.,Takeichi, H., Kawai, K., Death
during surgery in Japan. Lancet 2002; 360: 804-805
(5). Nakajima, K., Keyes, C., Kuroyanagi, T., et al; Medical
Malpractice and legal resolution system in Japan. JAMA 2001; 285:1632-1640
(6).Herbert, P.C., Levin, A.V., Robertson, G., Bioethics for
clinicians:23. Disclosure of medical errors. CMAJ 2001; 164:509-13
(7). Asai, A., Kishino, M., Fukui, T., Post-graduate education in
medical ethics in Japan. Medical Education 1998; 32:1-5
(8).Mission, J., A review of clinical risk management. J Qual Clin
Pract 2001;(4)131-134)
Competing interests:
None declared
Competing interests:
No competing interests
21 October 2003
Ediriweera B.R., Desapriya
Research Associate
BC injury Research and Prevention Unit, Centre for community Child health Research, BC, V6H 3V4
Medical Malpractices in Japan
Medical malpractices in Japan
Medical injuries incurred by patients while in hospital result in longer
hospital stays, increased hospital charges, and more than 30 000 deaths
each year in US (1). Adverse events and medical errors affecting patient
care are recognized internationally as major problems in medicine. The
failure of health care professionals and health institutes to address this
problem has threatened to undermine public confidence in the health care
system as a whole (2). There were 15,003, medical malpractices reported at
the Japan’s 82 special-function hospitals which involved 387 patient
deaths or other serious injuries, according to a Health Ministry survey
report released recently. The report further reveals that there were
186,000 cases in which accidents nearly occurred. The performance of
Japanese doctors has come under scrutiny after a series of embarrassing
and tragic mistakes (3).
According to the Doctor's Act in Japan, doctors must report cases of
unusual death to the police. However, in Japan, medical accidents are
rarely reported nor autopsied (roughly 4•3% overall autopsy rate). In UK
medical accidents and other unusual deaths are frequently autopsied
(overall rate 24%) (4).
Little is known about the Japanese malpractice environment because claim
information has been closely guarded. The lack of data on all claims
hinders adequate evaluation of dispute resolution methods, development of
appropriate risk management activities, and proactive education for
Japanese physicians (5).
It is necessary to create at least now a environment of “culture of
openness” in which errors are reported and then dissected to reveal
underlying causes so that future mistakes can be prevented. A profound
change in the culture surrounding medical error that is shifting the
emphasis from silence to safety is required for achieve overall patient
safety (6). In the past decade, Japanese researchers have conducted
various clinical studies in regard to ethical problems in clinical
settings. These studies have revealed that truth telling is not regarded
as a standard aspect of care in Japan (7).
A very good program was highlighted by the international medical
community, which was in operation in Australia called “Privileged
disclosure of medical errors”. Through the Australian Incident Monitoring
Study (AIMS), health care workers in many states are voluntarily and
anonymously reporting incidents and accidents.
This “culture of safety” is
essential to allay public health community fears and reprisals not only in
Japan but also in other countries as well.
A recent media article “Greater accountability for malpractice sought” it
was highlighted the crucial issues about increasing medical malpractices
in Japan and government intended proposed prevention programme by revising
the Medical service law. Action to reduce clinical risk should not include
punitive actions against the people who make the mistakes, but rather
action on the systems in which the mistake occurred. In the complex
environment of acute health, it is very common and surprisingly simple for
medical errors to occur. The health care system is significantly behind
other high-risk industries in its attention to ensure basic safety (8).
The key behind reducing clinical errors is to make it difficult to do the
wrong thing, and easy to do the right thing. A public health approach
requires medical community and organizations to participate in a
coordinated effort to understand the nature and extent of medically
induced injuries through a sophisticated surveillance system and to
establish systematic prevention strategies.
References:
(1).Mayor S., Medical injuries in US hospitals cause more than 30 000
deaths each year BMJ 2003; 327:887
(2).Herbert, P.C., Adverse disclosure of adverse events and errors in
health care: an ethical perspective. Drug Saf. 2001; 24:1095-104
(3).Watts, J., Are Japan’s medical sensei losing the public’s
respect? Lancet 2000; 355: 994-995.
(4). Ken-ichi Yoshida, K., Kuroki, H.,Takeichi, H., Kawai, K., Death
during surgery in Japan. Lancet 2002; 360: 804-805
(5). Nakajima, K., Keyes, C., Kuroyanagi, T., et al; Medical
Malpractice and legal resolution system in Japan. JAMA 2001; 285:1632-1640
(6).Herbert, P.C., Levin, A.V., Robertson, G., Bioethics for
clinicians:23. Disclosure of medical errors. CMAJ 2001; 164:509-13
(7). Asai, A., Kishino, M., Fukui, T., Post-graduate education in
medical ethics in Japan. Medical Education 1998; 32:1-5
(8).Mission, J., A review of clinical risk management. J Qual Clin
Pract 2001;(4)131-134)
Competing interests:
None declared
Competing interests: No competing interests