What Causes Health Care Errors?

Medical errors happen when something that was planned as a part of medical care does not work out or when the wrong plan was used in the first place. Medical error and mistakes can occur anywhere in the healthcare system; in hospitals, clinics, outpatient surgery centers, doctor’s offices, nursing homes, pharmacies and even at a patient’s home. Deficiencies in system design can create problems at many levels. Errors can involve medicines, surgery, diagnosis, equipment, lab reports and so on. They can happen during even in the most routine tasks, such as when a hospital patient on a salt-free diet is given a high-salt meal.

Common causes of medical errors include:

i. Fundamental difficulties in medical care: Providing health care is a difficult task and it is expected for some level of mistakes to occur. This involves the basic difficulty in balancing the need to double-check to avoid diagnosis errors with the need to avoid over-testing. The impossibility of doctors, and even specialists, of staying up-to-date for every condition they face in their work. As well as the impossibility of doctors to give totally accurate medical care when only a brief time is available for appointments for each patient

ii. General medical industry system problems: The medical industry overall contributes to higher than necessary rates of medical mistakes. Although some errors are unavoidable, the industry could do much better. These mistakes can be attributed to under-funded medical care, inefficiency leading to poorly used funds, over-busy doctors and other medical staff, over-tired doctors from excessive time schedules, slow adoption of new technologies, failure to report medical errors for fear of lawsuits, making errors hard to monitor and correct. In addiction to this, unnecessary medical tests to double and triple-check, from fear of lawsuits.

iii. Individual doctor mistakes: The doctor can obviously make a mistake in various ways. Such as simple human mistakes which everyone can make, even the best doctors. Mistakes caused by doctors who are drunk or on illicit drugs. Poor handwriting of prescriptions can lead to errors in filling prescriptions or wrong hospital medications or tests. As well as poor dosage instructions which can make it difficult to read numbers, such as zeroes and decimal points, can lead to wrong dosages.

iv. Patient mistakes: The patient can contribute to an error occurring in their health care. Some patients do not tell the doctor about all their symptoms for various reasons like embarrassment, thinking it will be irrelevant, the doctor didn't specifically ask about it, and so on. In some cases the patient delays in reporting symptoms. Other issues include failure to report other medications a patient is on, either prescription or over-the-counter medications. Not agreeing with the treatment plan or medications because of financial troubles, laziness and so on. Dishonesty of patients most notably in certain factitious syndromes, desire to obtain restricted drugs, malingering, insurance fraud or simply trying to get time off work. A patient may also fear legal issues by admitting they are taking illicit drugs, fear of social issues by admitting to lifestyle or social habits. Fear of doctor scolding if the patient fails to follow treatments or the patient may have problems in reading medication labels and instructions fully. The patient may in fact pressure the doctor into prescribing certain treatments such as antibiotics, sleeping pills, or behavioral drugs, even when they may not be in the best interests of health.

v. Pharmacist mistakes: The dispensing of medications at the pharmacy can be the source of various mistakes. Such as administering the wrong medication, dosage and failure to communicate instructions on taking medication, mistakes because of similarly labelled or packaged medications wrongly given and similarly named medications confused by the doctor or the pharmacist.

vi. Pathology laboratory mistakes: The various laboratory tests used for diagnosis (and sometimes treatment planning) can have several types of errors like errors in labeling samples, cross-contamination during testing, basic known risks in various tests that is, getting a false positive or false negative result, limitations of certain tests for certain patients and human error in examining visual slides for instance in cell biopsy or pap smears.

vii. Pharmaceutical industry mistakes: The drug industry has contributed to certain medical mistakes such as similarities in medication brand names and the inadequate safety testing of some drugs leading to drug withdrawal.

viii. Hospital mistakes: The hospital is a large institution that can make numerous types of mistakes. Nosocomial infections, infections that are caught during a hospital stay, either from the environment or from surgery or other treatments, surgical mistakes, errors in transferring and re-labeling medicines into smaller containers, and medication errors by administering the wrong medication, wrong dosage, and so forth.

ix. Surgical mistakes: Any type of surgical procedure has various risks and there are certain errors that can occur. Such as wrong patient surgery, wrong site surgery for example surgery on the wrong organ, failure to suspend other medications before/during/after surgery.

References:
Agency for Healthcare Research and Quality, (2000). 20 Tips To Help Prevent Medical Errors (p. 1 –4), Rockville, MD, USA, AHRQ Publication [available at http://www.ahrq.gov/consumer/20tips.htm] [viewed on 19/11/2008]

Health Grades Inc., (2008). Causes of Medical Mistakes http://www.wrongdiagnosis.com/mistakes/causes.htm [viewed on 30/11/2008]

World Health Organization, (2006). Working Together for Health the World Health Report 2006 (p. 28 – 29), Geneva Switzerland, WHO Library Cataloging-in-Publication Data 

Article is a segment of a past assignment entitled, "Medical Errors" written for Charels University in Prague, 2008.