Good Doctors Spot Mistakes, Save Lives

In 2000, the Institute of Medicine published a book called "To Err Is Human," which claimed that as many as 100,000 patients are killed each year by medical error. A death from error is one thing; leaving a sponge behind is a less fatal but still stunning mistake.

The Institute for Health Care Improvement calculated last year that the medical profession inflicts 15 million "incidents of harm" (like a retained sponge) per year in this country.

The reasons for these almost unbelievable figures are multiple and interrelated. Medicine today is complex. Because medicine is a "profession" and many years of training are required to practice it, it is assumed that doctors have the patients' best interests at heart. But without any central database for our care, a patient I plan to operate on next week may be, right now, in a doctor's office getting a prescription for a drug that will make the proposed operation more dangerous. Unless I ask, I'll never know.

In addition, there are many more drugs, procedures and techniques today than when I graduated from medical school in 1970, yet we haven't learned how to keep up with it all. Information travels remarkably slowly in medicine.

Then there is the culture of the medical profession. Uncooperative behavior by physicians has been tolerated by frustrated nurses and hospital administrators whose bonuses are tied to the hospital revenue generated by these doctors. Intimidating behavior has long been a facet of surgical training. I learned from the best: surgeons who would slap residents during a case, intimidate nurses or throw instruments. Most didn't, but some did.

Recently a cardiac-catheterization-lab nurse told me she'd tried to get a cardiologist to use the right "guide wire" for an arterial catheter. He ignored her hint and perforated the patient's aorta, then told the family that the accident and subsequent emergency surgery were the nurse's fault. "Do you think I'll ever try to help him again?" she asked.