Correspondence

Views of Practicing Physicians and the Public on Medical Errors

N Engl J Med 2003; 348:1184-1185March 20, 2003

Article

To the Editor:

Physicians underestimate the degree to which medical care, which was formerly simple, ineffective, and safe, is now complex, effective, and unsafe. Blendon et al. (Dec. 12 issue)1 report that physicians are aware of medical errors but believe that the report of the Institute of Medicine seriously overstates the magnitude of the problem. Part of this misconception may be rooted in the psyche of physicians. Physicians, because of their background and training, tend to be success-oriented persons for whom failure is unthinkable. The expectation of infallibility demanded of physicians reinforces this attitude.

Our culture affixes blame for accidents — an outlook that hinders objective analysis of medical errors. One of the challenges facing health care will be to establish a culture of safety in a blame-free environment, thereby permitting appropriate analysis and implementation of effective solutions.

In moving toward a culture of safety, physicians may be well advised to turn to their colleagues in nursing. In a recent qualitative study,2 503 nurses from 22 Academic Health Sciences Centre institutions in Canada participated in 33 focus groups. The nurses in each group were asked six questions about safety in relation to their practice within the hospital. The responses were unequivocal. The nurses described the hospital environment as “chaotic” and “unsafe.” Twenty-three systems-related and patient-related themes emerged from the focus groups. These themes will provide a basis for further investigation into the factors that give rise to medical errors and the steps that will be needed to reduce the frequency and severity of the problems.

James A. Robblee, M.B.A., M.D.
University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
jrobblee@ottawaheart.ca

Wendy L. Nicklin, R.N., M.Sc.A., C.H.E.
Ottawa Hospital, Ottawa, ON K1Y 4W7, Canada

2 References

1. 1

   Blendon RJ, DesRoches CM, Brodie M, et al. Views of practicing physicians and the public on medical errors. N Engl J Med 2002;347:1933-1940
   Full Text | Web of Science | Medline

2. 2

   Nicklin W, McVeety JE. Canadian nurses' perceptions of patient safety in hospitals. Can J Nurs Leadersh 2002;15:11-21[Erratum, Can J Nurs Leadersh 2002;15(4):5.]
   Medline