A message that goes in rounds on social networking sites reads as under:
“What is safer? Guns or healthcare?” The answer was “Guns”.
This followed a statistical explanation. “There are 700,000 doctors in the US and 100,000 medical mishaps take place every year. There are some 1,600,000 guns which lead to some 1,500 accidents yearly. And most importantly, the need for healthcare is unavoidable and absolutely necessary to every individual, whereas, guns are not essential for life!
This sound scary… doesn’t it? But it is the blatant truth! Healthcare is supposed to cure people, protect them from diseases and improve the quality of life. However, the same system, sometimes, causes harm to the patients. All the healthcare professionals in India will know of at least one incidence in which the patient was harmed. We read such horror stories regularly in the newspapers. But you will be surprised to know that medical accidents are happening all over the world, no matter whether the country is rich or poor, developed or developing, and whether it is the private sector or the government sector. Medical accidents and harm caused to the patients are a serious problem, realized by increasing number of healthcare systems across the globe. We have always believed that it is the carelessness and callousness of bad and incompetent doctors or healthcare professionals which is the cause of such unfortunate incidences or mishaps. We attribute such incidences to someone’s mistake, error or negligence.
Differentiating mistake & error
The words ‘mistake’ and ‘error’ are used as synonyms in our day to day life. It is important that we analyse these two words. I remember a chapter in the Physics textbook when I was in the ninth grade. It had explained the meaning of these two words and also differentiated one from the other.
Imagine that I have been given a foot ruler with marks after every centimeter. Now I am asked to measure the distance between two points. Let’s say the actual distance is 2 centimeters but I measure it as 3. This is a mistake. All humans are prone to make mistakes. On the other hand, imagine that the distance between the two points is saying two and half centimeters. When I have a ruler with centimeter marks, measuring the distance between the two points cannot be accurate at all. It is the limitation of the system to measure this distance. This is termed as an Error. We can say that the system is making the person measure the distance inaccurately. Thus, medical mishaps can be because simple mistakes made by individuals or they can be because of limitations of the systems in which the professionals work!
When we talk of ‘mishaps in the medical world’, it does not have to lead to the death of a patient or any actual harm to the patient. For example: if a wrong injection is readied and taken to the patient, but not administered, this is also is a potential mishap. Or let’s say a wrong injection is given, but it does not lead to any side effect or reaction on the patient. What matters in these examples is the threat or potential of causing harm to the patient. Such incidences have to be avoided.
The magnitudes of such incidences or accidents (which are called as ‘patient safety incidences’) are as high as any major contagious disease. According to the World Health Organization – “Unintended errors in healthcare” is the ninth common cause because of which people in the world die! This is mind-boggling. The solutions to this super major problem cannot be brought by doctors or managers in isolation. As a matter of fact, this is a problem of the society at large. To find a solution to this menace, the World Health Organization has started a separate department called “World Alliance for Patients’ Safety”.
The nation shook with furor Even the USA didn’t have much information about this problem few years back. In 1991, Dr. Lucian Leap, a physician, through his revolutionary research, shook the nation with furor. Under the guidance of Leap, 30,000 cases in different hospitals in New York were taken for analysis. He published the results in the reputed ‘New England Journal of Medicine’. The inferences were shocking.
Out of 30,000, four per cent of the patients were harmed. Even more surprising was the fact that most of the patients were harmed by the limitations of the system or errors or simple human mistakes. In fact, the percentage of harm due to such behavior which can actually be termed as negligence was only one percent. This meant that in most of the cases, patients were harmed in spite of that fact that healthcare professionals were not negligent. This was a very puzzling inference. These findings were published on the front page of New York Times. There was a complete chaos.
Each stake holder had a different take and reaction! The consumer organisations harped on the magnitude of the harm. On the other hand, the Medical Council stated that they were happy to note that the incidence of negligent behavior was so low hinting that people are unnecessarily filing cases in the court against the doctors and hospitals. Many ‘so called intellectuals’ ridiculed Leap and called him a ‘stunt-man seeking cheap publicity’. The hospital authorities removed Leap from his job for exposing this classified information which brought disrepute to the hospital. But no one actually cared enough to pay attention to the fact that the mistakes/errors/accidents were happening and kept happening redundantly with no solution in view to address the problem.
Gradually people forgot the episode. Mishaps continued to occur. People continued to lose faith in doctors and hospitals. The court cases soared. Hospitals and doctors grew defensive. A strange tension and awkwardness started seeping into the doctor-patient relationship. Some discounted this under the name of ‘professionalism’. Some called this an inevitable outcome of consumer activism. But the original problem persisted. Nobody bothered about Dr. Leap’s research or his findings. In 1999, another research paper was published by the renowned organization Institute of Medicine in the US. The very title of the paper was “To err is human”.
In this report, once again, the authors had analysed mishaps and harm caused in health systems. The report claimed that across the globe, in various countries, the percentage of medical mishaps was between 4-15 per cent; averaging to around 10 per cent. All major newspapers and news channels published this report. One newspaper quantified these deaths equivalent to the number of deaths that could occur if two jumbo jets crashed per week in the USA! And the nation woke up… Another report stated that medical mishaps claimed around 40,000 to 98,000 per year in the USA. In addition to this, Institute of Medicine had one more relevant message. These mishaps were not due to the negligence or carelessness of the doctors or nurses. According to them, loopholes in the systems were root cause of such mishaps. It was a bad ‘system’ that was failing good healthcare professionals! The report had stated that if these loopholes were eradicated in time, 90 per cent of the mishaps could have been prevented.
While studying the history of the patient safety movement I was dumbstruck. Being a medical professional, I know of few errant doctors or nurses. I understand that mistakes happen due to lack of experience or lack of in-depth knowledge. I have also seen good and senior doctors and nurses making mistakes. Still I found it tough to digest and internalize the report by Institute of Medicine. We are seeing some spectacular revolutions in medicine and technology promising better life on the earth. And we have these huge figures of harm. How can one make sense of such contradiction? Why is the health care system so error prone and unsafe?
We will find answers to these questions in the articles to follow.
Till then, let’s discuss more about healthcare accidents in Indian hospitals. How often do you see the healthcare accidents happening at your workplace? What kind of accidents have you seen? Do visit www.patientsafetyalliance.in and leave in your comment.