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Death By Medicine: U.S. medical system creates errors

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U.S. medical system creates errors
United Press International
By PEGGY PECK, United Press International
Tuesday, May 4, 2004
Source: MedlinePlus

PHILADELPHIA, May 04, 2004 (United Press International via COMTEX) -- American doctors write about 3.5 billion prescriptions every year and new research suggests nearly one in every 100 of those prescriptions is wrong -- the wrong drug, the wrong dose or the wrong patient.

Of 28 million erroneous prescriptions written annually in the United States, most contain minor errors that do not hurt patients. But about 21 percent -- nearly 6 million -- contain "serious errors," according to Dr. Lucien Leape, an adjunct professor of health policy at the Harvard School of Public Health in Cambridge, Mass., who is considered the world's leading expert on medical errors.

Leape told a packed audience at the opening session of the American College of Obstetricians and Gynecologists meeting that he estimated those prescription error rates based on a study of office-based physicians.

Later, Leape told United Press International that his new study, which currently is being reviewed by a medical journal, uses data collected from four physician groups practicing in the Boston area. He said he thinks the error rate is the same at doctors' offices around the country because the U.S. medical system is designed in a way that promotes errors.

For instance, Leape noted that although training programs have been overhauled recently to cut down on the number of hours medical residents are on call, "there are no such limits on the hours of attending physicians." Thus, he said, senior physicians can be subject to same lack of sleep that threatens medical judgments in young doctors -- yet no one is policing the older doctors' work hours. In fact, a practice built on long hours commonly is considered the medical model.

Leape cited a medical practice in the Boston area that comprises 13 orthopedic surgeons.

"They decided to cover weekends by having one surgeon cover every 13 weeks, which sounds really good to surgeons who are used to covering every other weekend," he said. But this practice also defined weekends as Friday afternoon through Monday morning, "or roughly about 70 hours on call."

One weekend, Leape said, the covering physician performed 34 operations, a workload he said was likely to have impaired that surgeon's judgment and skill by the end of the weekend.

In the past, he said, medicine was "simple, relatively safe and ineffective. But today medicine is complicated -- we regularly perform miracles -- which has made it less safe, and it is still ineffective." The problem, he explained, is doctors continue to be trained to think by themselves and for themselves, rather than being team players.

Leape said the patient safety movement continues to struggle to gain momentum and he praised the obstetrician-gynecologist group for highlighting patient safety at its meeting, a move that set "ACOG apart from other professional societies," where patient safety is not considered an appropriate agenda item.

But physicians, nurses and other medical staff are not the only players needed to improve patient safety said Dr. Carolyn M. Clancy, director of the federal government's Agency for Healthcare Research and Quality in Washington, D.C., which tests the efficacy of different treatments and develops guidelines for good medical care. Clancy told UPI that "patients need to become participants in the patient safety movement."

For example, she said, patients can reduce the chance of receiving an erroneous prescription if they "arrive at the doctor's office with all the needed information, which includes a complete list of medications and a good knowledge of their medical history."

Using the example of people with diabetes, Clancy said her agency has determined most diabetic patients do not receive the proper medical care, including the needed checkups with attention to special concerns, such as kidney function and eye health. "But the diabetic patients know that they need this treatment, so they have some responsibility here, too," she said.

Dr. Benjamin Sachs, obstetrician-gynecologist-in-chief at Beth Israel Deaconess Hospital in Boston and a professor at Harvard Medical School, is another proponent of team-based care.

Sachs told UPI he is conducting a study to determine if team-based medicine -- a plan in which junior staff such as residents and nurses can question the decisions of senior physicians -- could reduce medical errors and if reducing the error rate could translate into cost savings.

Although he cautions that the data are preliminary, he said 43 percent of medical malpractice claims at his hospital could have been prevented or mitigated by initiating a team approach. Moreover, he said, already the new cooperative approach has reduced medical errors at his hospital, which has been rewarded with a 10 percent reduction in malpractice insurance premiums.

A reduction in malpractice premiums is good news, Leape said, but he cautioned against equating medical malpractice insurance gains with gains in patient safety.

"The tort system does not improve patient safety because it is all about blaming the individual," he said. For that reason, he supports no-fault insurance to cover medical injury rather than reforming the system by putting limits on the ability to sue or on the amount of money paid out in damages.

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Peggy Peck covers medical research and health issues for UPI Science News. E-mail sciencemail@upi.com


Copyright 2004 by United Press International.



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