Talk:Medical error

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Useful links (non encyclopaedic) chat at the BMJ

Ballpark figures not very helpful

Think of a number and double it? The first sentence of this article is one of the worst I have seen in Wkipedia, namely "In the United States medical error results in 44 000-98 000 unnecessary deaths each year...." What? Doesn't anyone actually have even a reasonable estimate? The 98,000 figure is 222 per cent higher that the 44,000 figure. We are saying that in 1990 (example) there were between 44 000 and 98 000 unnecessary deaths, and in 1981 there were between 44 000 and 98 000 unnecessary deaths. How can we exect Wikipedia to be taken seriously with such ballpark figures. Moriori (Sorry, forgot to sign).

dude. check the ref. Erich 04:20, 12 Jun 2004 (UTC)

There are no exact numbers on this because the numbers I have seen are all estimates based on extrapolations. That's right - the data is not good. And that the data is no good is even more alarming! Kd4ttc 19:19, 12 Jun 2004 (UTC)

I am astonished that User:Erich gasboy, a doctor, would defend a single set of data taken selectively from the tonnes of verbiage available through google. I wonder what he would say if I amended the intro to about 20,000 and gave [1] as the authority. Here's a quote from it -- the Institute of Medicine estimates that over 100,000 patients die every year in U.S. hospitals as a result of medical errors or mistakes…. and beginning in 1999 that dialogue was sold to the American public in newspaper banners and on TV news programs across the nation. However, the important story is that 80% or 80,000 of those 100,000 patients die from an infectious disease. This fact – published by the CDC – was noted in earlier reports in 1999, but seldom mentioned when reported on in recent years. The 80,000 who die from infectious diseases are conveniently ‘bundled in’ with the other 20,000, most of whom did die because of medical errors. I believe our current article is demonstrably lacking in integrity and is doing Wikipedia a great disservice.Moriori 23:59, Jun 12, 2004 (UTC)

Regarding the infections - these are largely preventable deaths themselves. Ventilator associated pneumonia and catheter related infections are examples of infections that are usually caused by poor systems (errors) in place that do not take the necessary steps to prevent such infections. --Jrmunch 04:46, 20 March 2006 (UTC)

Everyone in the hospital dies of an infectious disease. Well, a few die of cardiac arrest, but vastly more die of infectious diseases. A person allergic to penicillin falls and breaks a bone--far from a lethal injury. Goes to hospital, where broken bone is set by orthopaedic surgeon. Suffers anaphylactic reaction to penicillin-class antibiotic because his surgeon forgot to ask about medicine allergies. Gets intubated and sent to the ICU for anaphylaxis. Once in the ICU develops a pneumonia with a multidrug resistant organism. Dies with sepsis 3 days later. Death due to infectious disease or prescribing error? --Matdaddy 01:59, 4 Mar 2005 (UTC)

I prefer to quote peer-reviewed academic journals rather than anonymous web-sources.

Then quote them. You used [2] as a reference for the United States medical error results in 44 000-98 000 unnecessary deaths each year. That reference says no such thing. Moriori

oops that abstract does not give those figure - give me a mo and I'll find and online reference to those stats.Erich 04:34, 13 Jun 2004 (UTC)

Listen, feel free to improve the article if you like. This is a draft article on an important topic. I am a bit stunned by your comments "demonstrably lacking in integrity " and "doing Wikipedia a great disservice". Your reference goes on to clarify that the 80000 infections are also due to error. I've had a look at your contribs to try to understand your perspective, but still stunned really. Anyway if you like please have a look at the quoted refs from the peer-reviewed academic journals and feel free to help us knock of the rough edges of this article. cheers Erich 00:20, 13 Jun 2004 (UTC)

OK, fine. Can you say why a comparison to aviation is relevant?

aviation has an admired saftey culture and often put forward as what health should model itself on. this view does have critics.

The nuclear power industry is also often used as an example of a model of safety. The main point being that these industries have realized that human do make errors, and that the way to prevent them is to use good systems with redundancy that minimize the chance of an error happening or minimize its significance should it happen. --Jrmunch 04:52, 20 March 2006 (UTC)

Should carelessness be added to the section headed "Epidemiology of medical error"?

well that is consistent with the 'blame approach' to error [3]. fatigue, inexperience, overwork, inadequate supervision and lack of training are probably far more common than 'carelessness' though. personally I'm not keen to add carelessness but won't delete it if you add it, as I'm sure as humans we don't maintain 100% care at all times.

What exactly is meant by the following -- while error rates are reduced, the errors just become less likely .

geezz dunno... Steve?

Ideally the likelyhood is so low that the errors are extreemly unlikely?

well 'ideally' agreed. in reality errors happen all the time.

Can I have a go at the encyclopedic nature of this story, and you ensure the efficacy of the medical input? Moriori 01:52, Jun 13, 2004 (UTC)

please do! careful tho - the nuance can be subtle and this is a complex area. I'll work on added a few more refs and try to highlight the ones that it would pay you to look at. (apologies again for the misleading link above).. and if you think I get touchy... you haven't seen Steve stirred up ;-) Erich 04:34, 13 Jun 2004 (UTC)

I have to admit that I agree with person complaining that the avation comparison is irrelevant. What pilot ever jumps on a plane that is already crashing toward the ground, then given the blame when it hits the ground. —Preceding unsigned comment added by 69.221.131.218 (talk • contribs)

Much of the error prevention terminology and early research was developed by the aviation industry. The basic design is the same in aviation and medicine: a complex system with a lot of moving parts, and a human-technology interface. And the consequences of error are death or severe injury. Analytic methods such as root cause analysis and failure mode effects, and concepts such as standardization, process design and team training reduced errors in aviation and are being tried in medical error reduction now. So I think it has a lot to do with it. -- Ryanjo 03:26, 20 June 2006 (UTC)

Ball park figures & the Institute of Medicine Report

I added a link to the first paragraph of the article (reference #1) for the on-line version of the 2000 Institute of Medicine report, To Err is Human. This report led to the media quoting the 44,000 to 98,000 deaths yearly. As the Executive Summary section report, this was based on two studies (one in Utah and Colorado and one from New York) which were extrapolated to estimate total US mortality by multiplying by the number of hospital admissions. Unfortunately, the links to the references are dead, so we can't examine these studies themselves. (It might be possible to find them elsewhere; I'll try). In any case, the wide range of these estimates derives from the math; two different studies, and amplifying the data to millions of hospitalizations. Not that the point is diminished; a single avoidable death is a tragedy. -- Ryanjo 20:59, 20 June 2006 (UTC)

Medical Narcissism

I have inserted book by Banya. Medical narcissism is an area that needs to be covered.--Penbat 08:34, 6 October 2006 (UTC)

Merge proposal

This article should be merged with medical malpractice. Comments? -- FP ^{(talk)(edits)} 10:25, 18 November 2006 (UTC)

Oppose-This article covers the cause and correction of medical error. As I read the medical malpractice article, it covers the legal aspects (mostly). The distinction is useful. I have added a link to this article in medical malpractice, and vice versa. Ryanjo 15:44, 19 November 2006 (UTC)

OK, it looks like there is no interest in merging so I will leave the articles separate. -- FP ^{(talk)(edits)} 04:23, 25 November 2006 (UTC)

Quote from the article: "Humans are notorious for ignoring maintenance schedules and for non-compliance, while airplanes are not". Ahahaha, SO funny. :D 89.155.97.17 (talk) 19:10, 12 March 2008 (UTC)

adding DID/MPD to see also section

I have added this to the see also section because patients with these diagnosis are often misdiagnosed with other illnesses. ResearchEditor (talk) 02:38, 28 March 2008 (UTC)

See also is for links that attach to or are linked to the entire page. The mis-diagnosis of DID is only one aspect of the condition, and occupies a total of two sentences on the DID page proper. Embed the link in the text as an example if you must. There's no reason to have a single entry in which one, extremely controversial diagnosis (ergo it's arguable that it's medical error to fail to diagnose - if it's not a real condition, it's not a mis-diagnosis) is placed in the see also section as if it were linked in a major way to the entire DID page. Mis-diagnosis is one minor aspect of DID. Also, looking at the lead, the page focusses on unnecessary deaths and injuries. It's unlikely that the misdiagnosis is related handwriting, nurse to patient ratio, poor communication or similarly named medications. Of the examples of errors, the only one that arguably relates to the guts of the page is misdiagnosis, but as even the merck manual says, this may have more to do with skepticism than error. Placing DID in the see also section places undue weight on one aspect of DID. If you can build a section on misdiagnosis of mental illness in general, that would be a very good expansion to the page, as currently it does focus solely on physical conditions and misdiagnosis redirects here. Misdiagnosis does indeed encapsulate far more than just physical treatment errors so it makes sense to expand (or add) a focus on that aspect of medical error but please attempt to expand with more than just DID/MPD. WLU (talk) 18:37, 28 March 2008 (UTC)

Section has been added on misdiagnosis of psychological disorders, which includes information on schizophrenia and bipolar disorder. ResearchEditor (talk) 20:32, 30 March 2008 (UTC)

I do not believe that misdiagnosis is an appropriate section for this article, especially because the section is heavily filled with mental health which is diagnosed by ruling out other diagnoses and treated by a trial of which medications work for the individual. This is not a medical error or incompetence, this is the system we have in place and although worthy of discussion, not for this article. Symptoms of mental health disorders vary and are subjective, therefore based heavily on what the patient describes. If the patient only describes depression symptoms and leaves out any manic ones, because that is not why they are seeking treatment, how is a pattern for bipolar disorder supposed to be established?Kmartsbest (talk) 21:49, 29 August 2017 (UTC)

Neutrality disputed tag

The article has a "Neutrality disputed" tag from December 2007 which refers to a discusion on this page. I can find no discusion addressing this tag. And so will soon remove the tag as it appears not to be a current concern. others? SmithBlue (talk) 07:06, 26 April 2008 (UTC)

Agree, remove tag. Ryanjo (talk) 19:36, 27 April 2008 (UTC)

Neutrality tags have been removed. ResearchEditor (talk) 02:12, 9 May 2008 (UTC)

Book section removed

I am wondering why the entire book section was recently removed.

• Gawande, Atul. Complications: A Surgeon's Notes on an Imperfect Science. New York, NY: Metropolitan Books; 2002.

 

• Wachter, Robert and Shojania, Kaveh. Internal Bleeding: The Truth Behind America's Terrifying Edidemic of Medical Mistakes. New York, NY: Rugged Land; 2004.

 

• Banja, John Medical Errors and Medical Narcissism, 2005

 

• Porter, Michael E. and Olmsted Teisberg, Elizabeth Redefining Health Care: Creating Value-Based Competition on Results, 2006 ResearchEditor (talk) 02:12, 9 May 2008 (UTC)

I have restored this section temporarily. If there was a reason for its deletion, please cite here. ResearchEditor (talk) 03:40, 13 May 2008 (UTC)

The book section definitely belongs Smallbones (talk) 15:49, 13 May 2008 (UTC)

Iatrogenesis

I put the iatrogenesis link in the article. Unlike Medical malpractice I think there is a case for a merger between the 2 articles. I won't make or push that case however. FWIW, TIME Magazine quotes 90,000 annual US deaths from medical error in the article [[4]] on Peter Pronovost as one of the 100 most influential people in the world - No wikipedia article on him?! I have checked the spelling. Smallbones (talk) 15:49, 13 May 2008 (UTC)

Medical error vs. mistake?

Hello, I will soon sit in front of an inquiry commission on diagnostic errors in Pathology and have been thinking a lot about this. In the mind of a pathologist, an error is not synonymous with a mistake. Here is how I see it:

• Mistake: avoidable, results from misjudgement, inattention or negligence. Given a second chance, the person will not repeat his mistake. Example: administering a drug to the wrong patient.
• Error: unavoidable, results from the limits of scientific tools. Given a second chance, the professional will most likely repeat his error. Example: a negative HIV blood test in a patient with advanced AIDS (a well known limitation of this diagnostic test) causing a delay in his diagnosis and treatment.

This difference is very important when a professional is facing disciplinary action. Yet, it is not understood by most and is not clearly spelled out in dictionaries. What do you think? Can you find a reliable source explaining this? Emmanuelm (talk) 14:35, 30 May 2008 (UTC)

IMHO, the terms are synonymous, i.e. "I made an error" and "I made a mistake". Don't get caught up in the words; your examples call attention to the process. In the first example, the analysis was faulty ("human error"). In the second, information was false negative ("process error"). Most medical errors resulting in an adverse result are thought to be initiated by an human error (ie: not considering HIV, since a test is negative). This is allowed to occur, or not caught and corrected, by a flawed process (ie: lab does not suggest to clinician a repeat or confirmatory test).[5]

Your concept that human error is inevitable has a lot of support. In the conclusion of the analysis of the causes of adverse events from the Quality in Australian Health Care Study, the authors state:

Our study emphasises the need for designing safer systems for care which protect the patient from the inevitability of human error. These systems should provide new policies and protocols and technological support to aid the cognitive activities of clinicians.[6]

Regrettably, most inquiries are structured to lay blame on the individual, not to investigate the failed process that didn't correct the predictable human error.

Good luck. Ryanjo (talk) 19:20, 31 May 2008 (UTC)

Thank you Ryanjo, you are unfortunately right.

I'd like to clarify one point about the false-negative HIV blood test: this test detects antibodies against the HIV virus. AIDS causes immune deficiency, hence lower antibodies, including antibodies against the HIV virus. No matter how often you will repeat this test, it will be negative in these patients. Therefore, the lab made no error but the doctor might miss the diagnosis based on this lab test. Since laboratories suggest a confirmatory test only for positive tests, this false-negative can only be caught by the physician who saw the patient. Emmanuelm (talk) 01:26, 1 June 2008 (UTC)

Lay source

This magazine article might be an accessible source that interests some readers. It focuses on the difficulty of measuring errors. WhatamIdoing (talk) 01:44, 4 June 2009 (UTC)

Merge from healthcare error

Healthcare error seems to deal with the same subject. Medical error is the most prevalent term in Google with a 12x higher number of hits. Mikael Häggström (talk) 08:20, 20 December 2009 (UTC)

A thanks to Beland for having done the merge. Mikael Häggström (talk) 15:36, 16 January 2011 (UTC)

Merge from Preventable medical error

I don't think a separate article on Preventable medical error is needed, as medical error, in itself, is implied to be preventable, sometimes even being a part of its definition, as in its current article. The text in Preventable medical error appears to be equivalent to the sections Impact, Causes and Approaches to error in Medical error and should be merged to there. If the length of the article would ever require it to be forked, I think it should rather be forked into Prevention and something like Handling with errors once happened. Mikael Häggström (talk) 15:56, 16 January 2011 (UTC)

I performed the merge now. Some did not make a significant improvement to the target article, e.g. similar information and without reference, such as some facts on impact. These were not moved. I also skipped the further reading and external links, since there were already a lot in the target article, but I invite anyone to do that part too if regarded necessary. Mikael Häggström (talk) 05:16, 22 January 2011 (UTC)

Merge of Iatrogenesis and medical error

Extended content

In the deletion proposal for Wikipedia:Articles for deletion/Medical harm, it is being said that Iatrogenesis and Medical error are the same thing, and that "medical error" is the best layman term for "iatrogenesis". If that is so, then these articles should merge. Supporting evidence of this presented in that discussion as provided by SW3 5DL are the following: Opoids, iatrogenic harm and disclosure of medical error Iatrogenic disease in the elderly Reducing the frequency of errors in medicine Reducing medication errors in the Neonatal intensive care unit Iatrogenesis and Medical Error – The Case for Medical Malpractice Litigation Dr. Arnold Relman, former editor of the New England Journal of Medicine: on Becoming a Patient In these sources, medical error and iatrogenic problems seem to be equivalent. It seems that the term "iatrogenesis" was only recently popularized, and when it was, a particular doctor tried to give it a meaning more nuanced than anyone actually adopted, and it does seem to me that the common usage of iatrogenesis is to mean medical error despite some small amount of usage otherwise. Related, the proposal at Wikipedia:Articles for deletion/Medical harm is also suggesting that Medical harm is best understood to mean medical error/iatrogenesis. MelanieN has said that iatrogenesis and medical error are not the same, and my initial thought was this also before seeing what SW3 5DL shared, but no distinction has yet been made to differentiate these two. Blue Rasberry (talk) 14:45, 11 June 2014 (UTC) I was thinking also - there are 25 other language Wikipedias which have articles for "iatrogenesis" and 7 other Wikipedias with articles on medical error. Furthermore, the other language Wikipedias are often actually using the term "iatrogenesis", which makes me think that there is international support for this term. Still, if these concepts are the same, I support the use of "medical error" as a common name rather than iatrogenesis. Blue Rasberry (talk) 20:27, 11 June 2014 (UTC) Bluerasberry, concerning the 25 other language Wikipedias on the matter, I can tell you that the article in Bulgarian is very strange, as I have never ever heard the word while--unfortunately for the health system in Bulgaria--"medical error" is heard often. There is no article in Turkish on iatrogenesis, and in my humble opinion rightly so. The third language I speak, English, is the one where someone has proposed the merger with very solid reasoning. Which means, I am for the merger. Örümcekadam (talk) 03:20, 14 June 2014 (UTC)

I forgot that I already began this discussion at Talk:Iatrogenesis#Merge_of_Iatrogenesis_and_medical_error. I copied all this content there, and the discussion should happen there. Blue Rasberry (talk) 16:44, 14 June 2014 (UTC)

Medical error—the third leading cause of death in the US

New source that may be a good addition here: http://www.bmj.com/content/353/bmj.i2139 2001:56A:75B7:9B00:5825:265:E234:AE34 (talk) 21:29, 4 May 2016 (UTC)

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Outdated resources

The sources does not seem to support the claim under Competency Education and Training, first sentence number 34 resource is from 1991 and is based on a questionnaire at one facility, questioning if it is really a reliable source? I think it needs to be updated or removed as it refers to one facility and is not backed by other studies.TLund (talk) 17:34, 29 August 2017 (UTC)

I agree, not every reference is verifiable because prefaces and non-full text documents are cited, nor are they reliable because web sources and not academic are used. In addition, many of them are outdated and some even conflict with one another, possibly due to the difference in age. Kmartsbest (talk) 21:39, 29 August 2017 (UTC)

This is a complicated topic with multiple perspectives and approaches to discuss. Healthcare advances make maintaining accurate up to date information difficult. That being said, much of this article needs fresh data.Trinalynnie (talk) 20:58, 31 August 2017 (UTC)

Citation Evaluation

I was reading this article and evaluating its citations. The frequency seemed adequate; there were more than one citations in each paragraph. However, there were more than a few cases of close paraphrasing which should be edited to avoid plagiarism. I also noticed that in the "Impact" section of your article, in the third paragraph, the author addresses the views of "some researchers" which should be elaborated upon in order to make it less vague and therefore, a stronger article. Shilpaus76 (talk) 17:06, 4 September 2017 (UTC)shilpaus76

Expanding on a Sections/ Updating Sources

This article seems to cover quite a bit of reasoning behind the causes of medical error, but certain sections need to be expanded on. Under the Causes section, Healthcare Complexity states that prolonged hospital stays, drugs, and technology can contribute to errors but in what ways? I think it would benefit the reader to have this expanded upon. Most of the sections under Causes could benefit from some clarification and expansion to accurately represent all view points of this topic. Also, many of the sources are over 5 years old, some even 10 years. This article could benefit from source updating since prevention of medical error is a popular topic in healthcare now. Alliacev (talk) 01:12, 5 September 2017 (UTC)

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Lack of technology discussion

As far as I can see, there's little discussion of technology in this article. Technology can both create medical error (e.g., bugs in EHR software) and prevent medical error. This article A millionaire’s mission: Stop hospitals from killing their patients by medical error (2017) discusses a technology company which may be trying to help prevent errors. In addition, the idea behind decision support system and AI is to reduce medical error, but can of course also increase it... II | (t - c) 20:29, 24 June 2019 (UTC)

Increased psychiatry portion

Added following portion

Delayed sleep phase disorder is often confused with: psychophysiological insomnia; depression; psychiatric disorders such as schizophrenia, ADHD or ADD; other sleep disorders; or school refusal. Practitioners of sleep medicine point out the dismally low rate of accurate diagnosis of the disorder, and have often asked for better physician education on sleep disorders.

Cluster headaches are often misdiagnosed, mismanaged, or undiagnosed for many years; they may be confused with migraine, "cluster-like" headache (or mimics), CH subtypes, other TACs ( trigeminal autonomic cephalalgias), or other types of primary or secondary headache syndrome. Cluster-like head pain may be diagnosed as secondary headache rather than cluster headache. Under-recognition of CH by health care professionals is reflected in consistent findings in Europe and the United States that the average time to diagnosis is around seven years.

Asperger and Autism tend to get undiagnosed or delayed recognition and delayed diagnosis, or misdiagnosed. Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.,

2405:204:4313:D858:55AE:1695:FFA7:219F (talk) 13:26, 24 August 2019 (UTC)

References

Requesting a section on physical disease not only psychological.

Misdiagnosis of very common physical illness including infectious diseases are sometimes frequently misdiagnosed. Such as various disease showing symptom of fever; such as malaria, hepatitis, typhoid, paratyphoid, influenza can look confusingly similar, and getting a correct diagnosis could be a long loop due to atypical symptoms. Have experienced physical intrusions in E/N/T was mistaken as tumour by very large number (about ten or more) doctors it is because all these doctors were thinking "in the box". And if a person has somewhat uncommon disorder, misdiagnosis is quite inevitable.

2405:204:4313:D858:55AE:1695:FFA7:219F (talk) 13:47, 24 August 2019 (UTC)

need original author or anyone who's in the capacity to elaborate the paragraph of Difficulties in measuring frequency of errors listed below

@Erich gasboy:["For example, if a doctor fails to order a mammogram that is past due, this mistake will not show up in the first type of study. In addition, because no adverse event occurred during the short follow-up of the study, the mistake also would not show up in the second type of study because only the principal treatment plans were critiqued. However, the mistake would be recorded in the third type of study. If a doctor recommends an unnecessary treatment or test, it may not show in any of these types of studies."]I find the cited references not helpful for me(sorry). I'm now working on the translation into traditional Chinese. Thanks in advance.

ThomasYehYeh (talk) 10:55, 3 December 2020 (UTC)

References

Medical prescriptions

In the section with this title a statement is made "in the U.S. legibility of handwritten prescriptions has been indirectly responsible for at least 7,000 deaths annually.[83]"

On reading the cited reference, "APPEAL NO. 991681 Texas v. Dr. K" (PDF). Retrieved April 16, 2020. I find nothing to support that statement. I think this reference should not be cited in this section. Gnuarm (talk) 03:48, 4 February 2021 (UTC)

Gnuarm, I agree that a lawsuit is not an appropriate source for this kind of information. It's widely known that handwritten prescriptions have resulted in people getting the wrong drug or dose, but I'm not sure that it was 7,000 deaths per year ever, and as handwritten prescriptions are uncommon now, presumably it's additionally an outdated statistic. Would you like to edit the page and remove that, or to replace it with a better supported claim? WhatamIdoing (talk) 19:27, 8 February 2021 (UTC)

Warning at the top of the article that this only covers US

I noticed the warning label. I did some work re-organizing the article and also improved the prevention section (please feel free to add to it and continue to improve!). I also tried to organize the US information into US-specific subheadings. I think the article could still very much benefit from more international evidence, however, I wonder what the community thinks about removing this warning. Let me know what you think! The label was placed in 2010.

JenOttawa (talk) 16:12, 17 July 2023 (UTC)

Mislabelled information in Impacts>UK

The second paragraph of the UK segment under the subheading "Impacts", the data is about US hospitals not UK hospitals the attached reference shows this.

I didn't want to move it myself as it would leave the UK section a stub and bloat the US section. Pluxxus (talk) 15:24, 10 November 2023 (UTC)