Skip to main content

Government Wants Patients to Report Medical Mistakes - Is This a Mistake?

I’m all for enhancing patient safety.  Count me in on reducing medical errors.  I acknowledge that medical mistakes harm patients and many can be prevented.  The medical profession should promulgate and support any initiative that accomplishes these objectives.
The public has become suspicious of the medical community who seem to circle the wagons when external scrutiny of its actions is threatened.  Yes, sunlight is the best disinfectant, but many of these shining lights are murky shadows that do not illuminate as intended.
Murky Sunlight
Copyright Christopher Down
The government and insurance companies are now providing financial penalties if certain medical quality benchmarks are not met.  While this sounds attractive and overdue when it is expressed in a headline or a slogan, the true motivations and capability of these efforts have been questioned.  Is it really about safety? 
I have tried to expose throughout this blog the fallacy that the medical malpractice system serves as a deterrent and improves medical quality.  I reject this lame claim and maintain that this unfair medical malpractice system diminishes medical performance and harms patients.  For those, who dare to enter this chamber of horrors, I invite you to bravely peruse the posts that are securely stored in the Legal Quality category of this blog.   I have commented on various plaintiff attorneys’ blogs and I’m always struck how so many of them feel that the current system is well designed,  fair and provides necessary justice to their injured clients.  I regard much of this as self-serving ideology that crumbles through gaping credibility cracks.   Would we regard a physician as credible who vigorously opined that our health care system needs no reform?
Our government has a new initiative to protect patients.  In this pilot program, patients would notify the government of suspected medical errors by doctors, pharmacists and hospitals.  An investigation would ensue.
Good idea?  Sure, the concept is reasonable but how would it be implemented?  Realize that most of the reported ‘errors’ would not be mistakes at all, just as most lawsuits against doctors are ultimately dismissed as no true negligence was present or could be proved.  Many of these ‘errors’ would be recognized complications of medical treatment which are blameless events.  Other complaints might relate to perceived inadequate physician communication or indifferent bedside manners.  Other true errors might be too minor to warrant reporting such as a patient’s IV (intravenous) line had to be inserted repeatedly or a patient was given the wrong meal which resulted in no untoward effect. 
Medical records would have to be reviewed in every case and medical personnel interviewed to try to ascertain the facts.  Where would we summon the manpower and the resources to investigate the gazillions of complaints that would be forthcoming once sick folks and their families are encouraged to serve as medical quality officers with a duty to report to serve the greater good? 
Even in a medical malpractice case, it is vexing to discover the truth after months of intense medical record scrutiny, discovery and depositions.   How would this new system aim to get to the truth after a cursory review of the circumstances?
One way to encourage physician support of such as effort would be if the facts and opinions that are uncovered would be kept confidential and privileged from use by the plaintiffs’ bar.  With this provision, then we would know that safety is the priority objective.
Finally, I think that medical error reporting should be reported to hospitals where the alleged errors occurred, and not to the federal government.  The hospital is much better suited to provide review and oversight of its own patients and personnel.  They know the players and are better positioned to evaluate the situation thoroughly and efficiently. I recognize that there is a conflict of interest here and that there would need to be independent voices participating to assure that there is no cover up or slanting of the facts to protect those who have erred or the institution.
Does this post agitate you?  Have I strayed beyond the Bloggers Code of Ethics?  Have I made a mistake here or even been negligent?    Your role is clear.  I am a practicing doctor.  You think I have erred.  Now, do the right thing.  Report me.  


  1. I believe you have focused in on the important nuance here. It is key to bring patients into the feedback process. They are in unique positions to identify when care delivery goes awry or when things happen which are undesirable and may go unnoticed. Physicians should welcome systems which help them identify what are areas needing improvement in time frames which are clinically relevant.

    However, the primary team involved in these sorts of efforts should not include the state. We have already concentrated state power to an unhealthy degree and placing them front and center in error reporting will have a chilling effect.

  2. Agree, particularly with your final sentence.

  3. I recently attended a hospital surgery meeting at which we discussed the importance of complying with safety benchmarks. One problem benchmark: Not all patients were getting their I.V. antibiotics infused within an hour of the surgeon's incision. Some hospitals reported 100% compliance (I'd check accuracy of those reports before running with that statistic); our hospital fell short. An anesthesiologist brought up a small problem: Some patients receive Vancomycin, which must be infused slowly due to its toxicity. Hence, the infusion can before that magical one hour. An administrator suggested patients receive an alternative antibiotic...or start a second infusion of Vancomycin that falls within the hour. (Yes, let's treat the benchmark, not the patient.) A surgeon pointed out that Vancomycin is often administered because the patient has an allergy to other antibiotics. I was disappointed that one of the administrators didn't suggest that we start the incision in the pre-op room, place a temporary bandage, and then continue surgery in the O.R. Perhaps THEN we could achieve 100% compliance.

    When I cook using Joy of Cooking recipes, the results are predictable. Recipes don't work so well with humans.

  4. " Many of these ‘errors’ would be recognized complications of medical treatment which are blameless events. Other complaints might relate to perceived inadequate physician communication or indifferent bedside manners. Other true errors might be too minor to warrant reporting such as a patient’s IV (intravenous) line had to be inserted repeatedly or a patient was given the wrong meal which resulted in no untoward effect. "

    The above quote reveals a troubling trivialization of a very serious subject. Here's what I know from my side of the stethoscope: I have experienced extreme indifference, extreme ignorance, extreme cruelty, extreme arrogance, extreme apathy, extreme negligence, and, quite occasionally, extreme excellence from doctors in my life. And I have seen many doctors. And it's not just me - friends and family, coworkers and acquaintances, have had similar experiences. One year I lost two coworkers because ER doctors kept turning them away, telling them they had, respectively, migraines and indigestion. One had a cerebral hemorrhage at work and was never able to work again, the other had a heart attack and died. Both had gone to the ER repeatedly in the months preceding their deaths.

    I myself had the quality of my life changed because of an undiagnosed illness.

    Medical errors ARE real. And serious. And common. And it seems like some in the medical community are finally noticing. That's great! But, in the meanwhile, change needs to happen. Now. If doctors won't join in and admit there is a huge problem, then you betcha the government should. I'm surprised the insurance companies haven't already.

    Thank you. Enjoy your blog.

  5. @Raymend, I regret that you have had such disappointing experience with the medical profession. What method of dealing with medical errors do you advocate? Do you support the current medical malpractice system, for example? Should we have a 'no fault' system? Are you mindful of the difference between an error and a blameless unfortunate event? Are you aware that the latter is often confused with the former?

  6. You have an interesting point, but I still am not sure I'm sold on your assertion that medical malpractice lawsuits harm patients. I think they can be an important (and effective!) tool for putting pressure on doctors and hospitals to improve their safety systems and the like. It's economics; if the cost of getting caught making mistakes outweighs the effort saved from being lazy (or whatever caused the error), the hospitals will work to reduce whatever is causing the errors in the first place. And at this point, with hundreds of thousands of patients being injured or killed by medical error every year, why wouldn't you want to do everything possible to reduce that?

  7. Rhonda, your comment deserves a thoughtful response. I would encourage you to read through a view of my postings in the Legal Quality category where I explain my view that challenged the premise of your comment. Thanks for your view.

  8. Hey - what is the name of the government's new program or what part of the government is running this program?


Post a Comment

Popular posts from this blog

Why Most Doctors Choose Employment

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

Why This Doctor Gave Up Telemedicine

During the pandemic, I engaged in telemedicine with my patients out of necessity.  This platform was already destined to become part of the medical landscape even prior to the pandemic.  COVID-19 accelerated the process.  The appeal is obvious.  Patients can have medical visits from their own homes without driving to the office, parking, checking in, finding their way to the office, biding time in the waiting room and then driving out afterwards.  And patients could consult physicians from far distances, even across state lines.  Most of the time invested in traditional office visits occurs before and after the actual visits.  So much time wasted! Indeed, telemedicine has answered the prayers of time management enthusiasts. At first, I was also intoxicated treating patients via cyberspace, or telemedically, if I may invent a term.   I could comfortably sink into my own couch in sweatpants as I guided patients through the heartbreak of hemorrhoids and the distress of diarrhea.   Clear

Solutions for Medical Burnout

Over the past few months, I’ve written enough posts on Medical Burnout that I have created a new category to house them.  Readers will find there posts detailing the causes and consequences of burnout in the medical profession. The profession has been long on the causes but short on solutions.   What must be done to loosen the burnout shackles from medical professionals? It will be a huge undertaking for caregivers and society at large to turn this ocean liner around.  And it will take time.  The first step must be to obtain a commitment to the overall mission from as many constituents as possible.   Support will be needed from medical professionals, hospital leadership and administrators, physician employers, insurance companies and the public.   As with many reform efforts, many of the players must be willing to sacrifice some of their own interests in order to server the greater good – a worthy and rare event.   Without adequate buy-in from stakeholders, the effort will never ge