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Docs And Public At Odds Over Errors

Most physicians believe that reducing medical errors should be a national priority, but are much less likely than the public to believe quality of care is a problem, according to a new survey.

The study in Monday's issue of the Archives of Internal Medicine also found that nearly all physicians believe fear of medical malpractice is a barrier to reporting of errors, and that greater legal safeguards are needed for reporting systems to be effective.

Congress is considering a bill by Rep. Nancy Johnson, R-Conn., that would create a voluntary, confidential system for reporting medical errors, but so far no action has been taken.

Experts said the study underlines the difficulties in creating such a system.

"There is widespread fear that reporting of errors would lead to more medical malpractice. I think physicians are always practicing with some unconscious fear of being sued because it's very prevalent," said Dr. Michael Fetters, an assistant professor of family medicine at the University of Michigan whose area of expertise is errors in primary care.

"There would have to be protections against legal repercussions for reporting" for a new system to be put in place, he said.

The study was conducted with a mail survey of 1,000 Colorado physicians and 1,000 other physicians across the United States, as well as a telephone survey of 500 Colorado households.

Respondents were asked to assess their agreement with several statements from a 1999 report by the Institute of Medicine that found preventable medical errors to be the eighth leading cause of death in America, contributing to up to 98,000 deaths annually.

The study found that 67.6 percent of people surveyed in households believed quality of care is a significant problem while just 29.1 percent of Colorado physicians and 34.9 percent of physicians nationwide agreed.

At the same time, 59.8 percent of the public said a national agency should be created to address medical errors while 24.1 percent of Colorado physicians and 32.2 percent of physicians nationwide would support that plan.

The author of the study, Dr. Andrew Robinson, an assistant professor of medicine at the University of Colorado Health Sciences Center and an internist at Presbyterian/St. Luke's Medical Center in Denver, said the study's most significant finding was the large discrepancy in opinion between the public and physicians.

"I think that's probably the biggest problem, but at the same time I think it has the benefit of perhaps driving change," he said.

Nearly all physicians surveyed - 92.9 percent in Colorado and 93.1 nationally - said more training is needed in handling of medical errors.

Robinson said he would like to hear suggestions from physicians on creating better systems for reporting medical errors.

Since the Institute of Medicine's report was issued, at least 20 states have created mandatory reporting systems.

Marilynn Rosenthal, a medical sociologist and adjunct professor at the University of Michigan medical school who has written and edited several books about medical errors, said she doesn't support a mandatory reporting system.

"The big problem is that medicine is not an exact science and there are various degrees of uncertainty. Very often when the outcome is not good, the patient thinks it was an error. In the doctor's mind, because of what they understand about the uncertainty of their work, it was a known risk," she said.

By Katherine Vogt

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