New York Medical College Department of Family Medicine1 Patient Safety and Medical Errors Family Medicine Clerkship New York Medical College 2003 – 2004 Joseph L. Halbach, MD, MPH

New York Medical College Department of Family Medicine2 Patient Safety and Medical Errors Today’s Discussion  Errors/Mistakes in general  Responses to mistakes  One brief description of a medical error  What responsible physicians experience after an error  Brief data on medical errors  What’s the problem  What to do as a medical student

New York Medical College Department of Family Medicine3 Patient Safety and Medical Errors Non-Medical Mistake  Think about a recent error or mistake that you made.  What was your reaction to making that mistake?

New York Medical College Department of Family Medicine4 “Jose Martinez” from The New York Times Magazine Patient Safety and Medical Errors

New York Medical College Department of Family Medicine5 “ The emotional impact of mistakes on family physicians.” Newman 1996  30 family physicians interviewed by a family physician. Memorable mistake Response to a hypothetical scenario in which a colleague’s decision was associated with a fatal outcome Patient Safety and Medical Errors

New York Medical College Department of Family Medicine6  24/ years old  26/30male  26/30married  27/30white  23/30remembered a mistake  5/30unable to remember a mistake  2/30had never made a mistake Patient Safety and Medical Errors

New York Medical College Department of Family Medicine7 Memorable mistake  18/23 family physicians who remembered making a mistake made their most memorable mistake post residency  Remembered mistakes occurred almost as often in their offices as in the hospital. Patient Safety and Medical Errors

New York Medical College Department of Family Medicine8 Reactions  96% reported self doubt  93% were disappointed in themselves  86% blamed themselves for the mistake  54% experienced shame  50% experienced fear Patient Safety and Medical Errors

New York Medical College Department of Family Medicine9 Support?  In response to their mistakes, all but one physician stated a need for support. 63% needed to talk to someone 48% needed validation of their decision making process 59% needed reaffirmation of their professional competency 30% needed reassurance of self worth Patient Safety and Medical Errors

New York Medical College Department of Family Medicine10 Source of support?  55% spouse  33% colleague Patient Safety and Medical Errors

New York Medical College Department of Family Medicine11 Hypothetical scenario  A colleague of yours recently saw a 54-year-old man in his office who was complaining of burning epigastric and lower retrosternal chest pain without radiation or other associated symptoms about an hour after lunch. In the office, the EKG showed some unifocal PVCs and some non-specific ST-T wave changes. After evaluating his patient’s condition, your colleague recommended that he take an antacid and return to the office in one week. Later that night, the patient was taken to the ER, unconscious, in V fib. The following morning, word has gotten around about how this attending physician missed an obvious and fatal MI. On making rounds, you see your colleague at the nurse’s station. Patient Safety and Medical Errors

New York Medical College Department of Family Medicine12  All but one family physician thought that their colleague needed support.  Nine (32%) would have offered support unconditionally  19 (68%) would have offered support if:  He/she were a close friend or partner  He/she first solicited their support Patient Safety and Medical Errors

New York Medical College Department of Family Medicine13 Epidemiology of medical errors  Incomplete picture 1984 Harvard Medical Practice study 1999 Colorado/Utah study 1999 report of the Institute of Medicine To Err Is Human Patient Safety and Medical Errors

New York Medical College Department of Family Medicine14  IOM reports 44,000-98,000 Americans die in hospitals each year as a result of medical errors.  8 th leading cause of death (surpassing MVAs, breast cancer, AIDS).  6% of national health care expenditures (1996).  7000 deaths from medication errors alone (1993). Patient Safety and Medical Errors

New York Medical College Department of Family Medicine15 What’s the PROBLEM(S)? (e.g., in the Jose Martinez case) Patient Safety and Medical Errors

New York Medical College Department of Family Medicine16 What would help to PREVENT ERRORS? Are there any RULES/REGULATIONS about what we should do/have to do? Patient Safety and Medical Errors

New York Medical College Department of Family Medicine17 What to do as a medical student? - M and M on the Web www/webmm.ahrq.gov Patient Safety and Medical Errors

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New York Medical College Department of Family Medicine21 What to do as a medical student: JCAHO National Patient Safety Goals #1Patient Identification #2Abbreviations #3Wrong site, wrong patient, wrong procedure Patient Safety and Medical Errors

New York Medical College Department of Family Medicine22 Summary Patient Safety and Medical Errors  Mistakes happen to everyone.  Good doctors make bad mistakes.  When we make an error, we need support.  Most errors result from system problems.  Open reporting and disclosure, not “shame and blame”.  Stayed informed!