Apr 8, 2020 in Medicine

The Medical Errors

Abstract

Professional activities of health workers are associated with a certain risk to commit wrong actions or take a wrong decision. This article examines such current healthcare problem as a medical error. The absence of its legal definition creates some difficulties in the delimitation of professional activities of health workers. It has led to the damage of the health or life of a patient from the innocent cases of causing harm, although related to the performance of professional duties. In this work, the classification of medical errors, their causes, and the ways to solve the issue will be given.

Also, the author will give an analysis of the profit of actions, which eliminate such problem as a medical error. The paper is organized in such a way that it gives a profound critical examination of the key issues in the field of medical mistakes providing a great necessity in studying them to prevent them.

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The problem of medical errors is one of the oldest one in medicine. The share of health care and medical defects is high enough. The number of people dying in the world on a daily basis from such mistakes is a complete interior passenger Boeing 747, also called the Jumbo Jet (about 500 persons), for every 100 thousand individuals. However, the crash causes massive attention while the quiet death in hospital is often left even without an analysis of reasons. According to the study recently published in the online magazine BMJ Quality and Safety, there are 43 million medical errors a year in the world.

Any medical professional in any country is not insured from making an error. Almost every day the media are reporting about the facts of patient complaints on the quality of medical services. The cases of damage to health or life of the person as a result of medical errors can be found in the US and several European countries. As published in various sources, from 50 to 100 thousand people die because of such mistakes in the United States annually.

Defects of care may lead to an unfavorable outcome. However, such result is not always a consequence of wrong actions of the medical staff. The position of the patient or the family in case of injury or death, considering this case as triggered by unprofessional actions of a doctor, is understandable from emotional and universal positions. However, the legal assessment of such effects may not coincide with the moral one. The question appears what the defect of health care Is. The following definition has been given in the scientific literature:

The defect of care is the improper implementation of diagnosis, treatment of the patient, health care organizations, which has led or could lead to the unfavorable outcome of medical intervention.

As the reasons for an adverse outcome, the authors include an untimely appeal for medical help, atypical disease, and an inability to cure the pathology with the medicine known for today. If this definition is analyzed from a legal point of view, the following fact can be concluded. The defects of health care cover the cases of misconduct acts carried out in violating of protocols, standards, regulations, prescribing a certain order, and a sequence of professional duties. On the other hand,  the reasons for possible defects speak about the factors that are outside medical practice. The mistakes of health care should be considered more widely, including not only the incidences of doctor misconducts, medical errors, and also iatrogenic diseases.

Medical and legal communities have different approaches to assessing the essence of medical errors. First, one should see it solely as a medical category that has nothing to do with the legal content. The actions of a health worker do not have the feature of guilt. For lawyers, a medical error to a greater extent is associated with the legal content. Certainly, it is impossible to agree that it is, above all, the question of the quality of professional work. It is necessary to remember that often the line that separates the medical error cases from illegal actions is very thin. Furthermore, legal consequences that may follow a doctor in one or other cases are significantly different. The purpose of this paper is to examine the causes and types of medical errors on the basis of the scientific literature, find the solutions to the issue, and study the potential benefits. These advantages will bring the elimination of the problem given.

Problem Statement

Medical errors are of the unrecognizable or disproportionate nature of actions and the severity of the pathological process. They are a natural progression that leads to an imminent threat (or its realization) of the life or health of a patient. Their appearance is the evidence of something unforeseen of the person being obliged to do one’s job under the special rule, i.e. in accordance with the canons of medicine or customs of medical practice. Therefore, in connection with the actual severity of consequences, the legal responsibility of such an individual appears. However, it occurs not in relation to how the provisions of relevant instructions have been completely met.

Medical errors, being the types of medical care defects, actually separate unlawful actions of medical workers from the cases of innocent harm caused by them. Not by chance, one of the problems in investigating a medical crime consists precisely in distinguishing innocent conducts and the cases of the improper performance of professional duties by medical and pharmaceutical employees.

Theoretically, the causes of medical errors are divided into objective and subjective ones. The first group is the lack of adequate assistance conditions when a doctor is forced to assist in an environment where it is impossible to provide help in accordance with accepted standards. It is also related to the incidences when an error is a consequence of incompleteness of an illness learned in medical science as well as the imperfection of existing treatments. The objective nature of the mistake lies in the atypical origin or rarity of diseases and associated complications. A Subjective error reasons may be related to missing medical professionalism; revaluating of laboratory data; and lacking of attention to the patient. 

In the USA, medical errors stand on the 5th place as a cause of death. In this country, due to medical errors or negligence of the medical staff five persons  die every 15 minutes. Considering the problem of medical mistakes, it is necessary to highlight some of the main points. First, in the world, there is no universally accepted definition of a medical error. Therefore, in our opinion, as the medicine is not mathematics, the mistakes happen within it. Second, the criminal codes of any state do not contain this term. The medical error as such, regardless of the consequences, has no punishment. Third, legally, the most crucial point is the differentiation of the elementary mistake from ignorance (or the lack of knowledge), negligence, and a crime. Fourth, in medicine, although rare, there is a random factor being difficult to forecast. Therefore, it may lead to unpredictable consequences. Fifth, the problem of medical errors cannot be reduced only because of the diagnosis and treatment issues. Sixth, in the world, there is no condition when doctors do not make mistakes.

Medical errors are an unfortunate flaw in medical practice. Unfortunately, it is impossible to imagine a doctor, even the elderly one, who has not committed some diagnostic and other professional errors. The thing is related to the unusual complexity of the object, which medicine has to do with, the roots of errors often go beyond the physician. The urgency of the problem of these mistakes has some objective preconditions. A sharply increased activity of modern diagnostic and treatment methods, as well as negative aspects of progressive specialization in medicine should be noted especially. The recording, classification, and study of medical errors should be carried out systematically and on a daily basis.

The presence of unpunished medical errors in the doctors’ practice does not mean the legitimacy of the commission. In fact, serious concerns of a common medical concept of mistakes as an inevitable phenomenon accompanying medical practice generates the representation of the certain right for making mistakes. This thesis is related to the right to commit an error is untenable from the point of view of logic (methodology) and value orientation. If the professional activity of doctors deliberately focuses on the mistake, it loses its humanistic nature.

The idea of the right for error demoralizes medical personnel. From a standpoint of medical ethics related to professional mistakes have to be irreconcilable. A broad public interest is doubtless in the reduction of medical errors and their prevention. The fundamental attitude of colleagues to the doctor’s failure in some cases should play the role of charges. Therefore, it is necessary and fair punishing a function of medical ethics. In other cases, the position of committed and competent colleagues should play the role of protection. Indeed, in certain moments, the doctor needs the moral and psychological rehabilitation. The destructive power of guilt for the professional error, at least to some extent, can thus be neutralized.

Literature Review

An analysis of the world literature shows that the problem of medical errors is significant for all countries without exception. Here are the data from the studies of the world practice. It should be noted the statistical information from different sources sometimes greatly differs. According to the report of the Medicine Institute of the USA National Academy of Sciences, each year, from 44 thousand to 98 thousand of people are killed in result of preventable medical errors in the US hospitals. According to this indicator, medical errors are on the 8th place in the list of leading causes of death. At the same time, the statement has considered only recognized by all (proven) adverse effects of erroneous interventions that occurred accidentally or unintentionally and resulted in death. In fact, according to Koehn, Ebright, and Draucker, medical errors happen much more frequently. In the US, in accordance with various sources, from 210 thousand to 440 thousands patients die from medical mistakes per year.

Hignett et al. have a strong conviction that the targeted research in the USA hospitals demonstrates that adverse reactions occur in 10% of patients. Medical errors have become a significant problem that was even established in the 1990s in the IOM Institute as ‘To Err is Human’. Its task is to collect the information about errors. After the publication of the Institute report patient safety has become an object of medical and public attention. The analysis has stated that the main cause of these mistakes and deaths that could have been avoided is not the negligence and incompetence of people though a bad system. Awareness and understanding of the reason of medical errors has received a rapid expansion in the country by an active movement for the safety of patients in favor of enhancing the quality of care with systemic solutions.

As a result of the studies conducted by the US experts, currently, in the United States, the death from medical errors takes the third place taking the lives of patients after heart disease and cancer. Hospitals have become an area of deadly infections spread. In the US, more than 2 million people a year suffer from hospital-acquired diseases. About 75 thousand of individuals die as a result. The most common hospital sicknesses include: drawing blood infection; the infection through urinary catheterization; and also the infection after a surgical operation.

Analyzing the study by Jin et al., it is possible to claim that the most of these cases probably could be easily prevented by simple infection control and hygiene procedures. For example, washing hands before handling each patient is a good practice and should be done routinely. A negative impact on health also has an improper use of antibiotics. It is complicated by the fact that a large part of this medicine is consumed by the population with food. Agriculture accounts for about 80% of all antibiotics used in the United States. The annual report by the United States Department of Health and Human Services notes that 22% of antibiotic resistance in humans is associated with a meal.

Analyzing risk factors, Kogan et al. state the following fact. There are also the income level of the population and the remoteness of hospital from an administrative center among others. In the hospitals located in remote areas, the likelihood of the above errors is higher. Regions and countries with the low income level have a higher sensitivity to medical mistakes. For example, the recent article in Today has noted that the likelihood that diabetics living in the areas with low income will undergo amputations is more than ten times higher than among the patients with diabetes in more safe regions. According to the studies, the causes of errors can be divided into several types. The most common reason is a human factor. The authors believe that the cause of violations in health care is an erroneous appointment of medicinal products. Other experts have designated the administrative mistake as the main reason.

Proposal for Change

As practice shows, medical errors cannot be avoided completely, but it is possible to minimize their number and impact. The inevitability of mistakes in medicine is determined by the specificity of clinical thinking. It is the lack of IT-one solutions. The other reason is that a clinical diagnosis always contains a larger or smaller share of hypothesis. Medical errors oppose to the clinical experience of every doctor. It is being formed, unfortunately, for many years. In general, clinical medicine is characterized by the theoretical underdevelopment. It can be partly explained by the lack of attention of clinicians and the medical  education system to the diagnostic theory.

The prevention of  medical errors requires a systemic approach that involves all levels of health care, including the further substantive examination, registration, and development of measures to prevent mistakes. On the basis of the international experience, it is necessary to develop some regulations on the level of the country to improve the quality and safety of care (the own accreditation standards).

Before talking about the inevitability of a medical error, the doctor should be provided with everything needed. Therefore, the medical practitioner could provide medical assistance at the appropriate level. In other words, the doctor should acquire knowledge in the university in accordance with the requirements of time. It is necessary to provide the one with the modern medical and diagnostic equipment.

The country should be responsible for doing this. Such events will eliminate a possibility of making a professional error. For the maximum safety of the patient and in order to minimize the incidence of adverse reactions health workers should avoid the following things. They should not do the unnecessary prescription of medicine; treat weak side effects caused by the use of one drug with the second one more toxic drug; misinterpret a side effect of the drug being designated with the newly developed disease, and appoint another drug as well as some medicine ignoring its correct dosing. In the absence of automated registration systems, health workers should legibly write prescriptions and use only standard abbreviations as well as doses descriptions. Most health facilities in order to reduce the error rate publish and distribute a list of relevant contractions related to drug treatment. 

Benefit Analysis

The concept of patient safety in health care is not new. Medical institutions set up their security program at the beginning of the 20th century. Traditionally, they were directed to willingness to assist in emergency, safety, environmental protection, and control of infectious diseases. The term patient safety, which means preventing the commission of medical errors, first was introduced by the American Society of Anesthesiologists in 1984. Its objectives were to evaluate the effect of anesthesia and the patients’ protection from its harmful effects.

Medical errors are the fifth leading cause of deaths among persons under treatment. Reducing the risk of mistakes in medicine will help to avoid the high mortality rate, responsibility, and publicity that will lead to the fact that doctors will be more cautious and diagnose more thoroughly. The human factor plays an important role in the diagnosis and treatment prescribed. However, the human attribute can have a positive impact on physician behavior. The doctor should understand the complete responsibility that will occur to the one in the event of the patient’s death or any complications of the illness because of the doctor’s mistake.

Conclusion

Medical errors are an inevitable part of the professional activity of each doctor. They were, are and will be present. It does not matter what technological advances have already been introduced into medicine of the 21st century. Therefore, any claim for the total elimination of medical errors is nothing more than an idle speculation of people representing the bad essence of the problem. At the same time, the desire to reduce the amount of mistakes in medicine is a very real goal, which requires a serious effort for the medical community and government institutions responsible for the health of the country. The healthcare system needs serious reforms and not only cosmetic repairs. As for the problem of medical errors, the official registration system should be developed. Such data bank will allow identifying the frequency, specialty, and causes of mistakes. Therefore, basing on the analysis and carrying out activities to prevent and combat the most common causes of erroneous medical action will be enacted. In each region, there should be an independent expert committee, composed of authoritative individuals. They will conduct a thorough analysis of all cases of conflicts and severe medical actions resulting in adverse outcomes or serious consequences in the diagnosis and treatment of patients. As for the broader discussion of mistakes in the media, it should take place after the completion of the analysis and decision both by the judicial or administrative authorities.  

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