Patient Safety and Doctors’ Fear–Improving Systems to Reduce Medical Error

The very people who take an oath to do no harm may be undermining patient safety systems, despite hospitals’ focus on reducing medical errors. In the last decade, hospitals have ramped up patient safety systems by promoting protocols, checklists, and procedures to prevent medical errors. Hospitals have also pushed to┬áincrease transparency and disclosure of medical errors. However, studies are showing that doctors are not reporting incidents of medical negligence as often as they should. Some experts point to doctors’ fear that an incident report with their name on it could damage their career permanently.

The Joint Commission Journal on Quality and Patient Safety reported last month that most medical residents have never filed an incident report. This is despite the fact that many residents are in fact reponsible for personal injuries or wrongful death of patients during their training. Additionally, young doctors are entering practice without being educated in patient safety, according to a report issued by experts working with the Lucian Leape Institute at the National Patient Safety Foundation. Dr. Lucian Leape, chairman of the report’s committee, blames the culture of medical education for the lack of attention to patient safety. Dr. Leape believes the hierarchy, humiliation, and stress of medical education does not allow doctors’ the time, sense of community, or support to disclose errors.

After historically ignoring patient safety, some medical schools and clinical training programs have introduced the subject into their curriculum. Not all institutions have succeeded, having difficulty securing financial support or experienced physician-teachers with training in patient safety. However, those institutions that have successfully implemented training programs have benefitted. The University of Illinois at Chicago College of Medicine instituted an extensive patient safety education program six years ago. Graduates of the school have gone on to be leaders in the field of patient safety. More recently, patient safety training was integrated into the residency program. Residents now submit over 100 incident reports- up from zero.

For more information on patient safety, see the National Patient Safety Foundation report. Also, see the New York Times article Learning to Keep Patients Safe in a Culture of Fear.

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