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Most people learn about medical mistakes through anecdotes. More than four out of five respondents have heard about a situation in which a medical mistake was made.111 When asked how they heard about the most recent medical mistake, 42 percent cited a friend or relative; 39 percent, television, newspaper, or radio; and 12 percent, personal experience.

Most people view medical mistakes as an "individual provider issue" rather than a failure in the process of delivering care in a complex delivery system. When asked about possible solutions to prevent medical mistakes, actions rated very effective by respondents were "keeping health care professionals with bad track records from providing care" (75 percent) and ''better training of health care professionals" (69 percent).112

There are numerous factors that might contribute to the "disconnect" between public perceptions and actual health care error rates. The various accreditation and licensure programs for health care organizations and providers have been promoted as "Good Housekeeping Seals of Approval," yet they fail to provide adequate assurance of a safe environment. Reducing medical errors and improving patient safety are not an explicit focus of these processes. Even licensed and accredited organizations may have implemented only rudimentary systems and processes to ensure patient safety.

For the most part, media coverage has been limited to occasional reporting of anecdotal cases. The impact of anecdotal information on safety may also be less effective in health care than in the nuclear waste or airline industries, where an individual event often impacts dozens or hundreds of people at a time.

Patient safety is also hindered through the liability system and the threat of malpractice, which discourages the disclosure of errors. The discoverability of data under legal proceedings encourages silence about errors committed or observed. Most errors and safety issues go undetected and unreported, both externally and within health care organizations.

References

1. Brennan, Troyen A.; Leape, Lucian L.; Laird, Nan M., et al. Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I. N Engl J Med. 324:370–376, 1991. See also: Leape, Lucian L.; Brennan, Troyen A.; Laird, Nan M., et al. The Nature of Adverse Events in Hospitalized Patients: Results of the Harvard Medical Practice Study II. N Engl J Med. 324(6):377–384, 1991. Thomas, Eric J.; Studdert, David M.; Burstin, Helen R., et al. Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado. Med Care forthcoming Spring 2000.

2. Thomas, Eric J.; Studdert, David M.; Newhouse, Joseph P., et al. Costs of Medi-



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