Views of Practicing Physicians and the Public on Medical Errors
Robert J. Blendon, Sc.D., Catherine M. DesRoches, Dr.P.H., Mollyann Brodie, Ph.D., John M. Benson, M.A., Allison B. Rosen, M.D., M.P.H., Eric Schneider, M.D., M.Sc., Drew E. Altman, Ph.D., Kinga Zapert, Ph.D., Melissa J. Herrmann, M.A., and Annie E. Steffenson, M.P.H.
Volume 347:1933-1940 December 12, 2002 Number 24
ABSTRACT
Background In response to the report by the Institute of Medicine on medical errors, national groups have recommended actions to reduce the occurrence of preventable medical errors. What is not known is the level of support for these proposed changes among practicing physicians and the public.
Methods We conducted parallel national surveys of 831 practicing physicians, who responded to mailed questionnaires, and 1207 members of the public, who were interviewed by telephone after selection with the use of random-digit dialing. Respondents were asked about the causes of and solutions to the problem of preventable medical errors and, on the basis of a clinical vignette, were asked what the consequences of an error should be.
Results Many physicians (35 percent) and members of the public (42 percent) reported errors in their own or a family member’s care, but neither group viewed medical errors as one of the most important problems in health care today. A majority of both groups believed that the number of in-hospital deaths due to preventable errors is lower than that reported by the Institute of Medicine. Physicians and the public disagreed on many of the underlying causes of errors and on effective strategies for reducing errors. Neither group believed that moving patients to high-volume centers would be a very effective strategy. The public and many physicians supported the use of sanctions against individual health professionals perceived as responsible for serious errors.
Conclusions Though substantial proportions of the public and practicing physicians report that they have had personal experience with medical errors, neither group has the sense of urgency expressed by many national organizations. To advance their agenda, national groups need to convince physicians, in particular, that the current proposals for reducing errors will be very effective.
MENLO PARK, Calif., Dec. 11 /PRNewswire/ – Some 42% of the public and more than one-third of U.S. doctors say they or their family members have experienced medical errors in the course of receiving medical care, with significant percentages reporting serious consequences, according to a new survey by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation.
However, implementing the actions recommended by experts on medical errors may not be easy. Despite widespread personal experience, neither the public nor physicians name medical errors as a top problem facing health care and medicine today. Physicians and the public also disagree about many proposed solutions.
The Harvard and Kaiser researchers discuss their findings in a New England Journal of Medicine article being published on December 12, 2002. The nationwide survey examined the views of 831 physicians in April-July 2002 and 1,207 adults in April-June 2002.
“One of the striking findings of this study is that physicians disagree with national experts on the effectiveness of many of the proposed solutions to the problem of medical errors,” said Robert Blendon, Sc.D., professor of Health Policy at the Harvard School of Public Health.
“This survey provides strong documentation that medical errors represent a problem that affects a significant number of people,” said Drew Altman, Ph.D., president and CEO of the Kaiser Family Foundation. “The fact that so many physicians report personal experiences with errors corroborates what we heard from the public,” Altman added.
Experience with Medical Errors
Both physicians and the public were read a common definition of a medical error early in the survey. Subsequently, 35% of physicians and 42% of the public reported experiencing a medical error in their own care or that of a family member at some point in their life; 18% of physicians and 24% of the public said an error caused “serious health consequences” such as death (reported by 7% of physicians and 10% of the public), long-term disability (6% and 11%, respectively) or severe pain (11% and 16%, respectively).
Three in 10 (29%) of all doctors said that in their role as a physician they had seen a medical error that resulted in serious harm to a patient in the last year, and a majority of those who had seen an error said it is “very likely” (15%) or “somewhat likely” (45%) that they would see a similar one at the same institution in the next year.
Not Viewed As A Top Problem Facing Health and Medicine
Doctors and the public agree that as many as half of the deaths due to medical errors could have been prevented, but neither group listed medical errors among the top “problems facing health care and medicine in the country today.” Only 5% of physicians and 6% of the public identified medical errors as a top concern.
Instead, when asked to name in an open-ended question the top problems facing health care and medicine today physicians identified malpractice insurance costs and lawsuits (29%), health care costs (27%), and problems with insurance companies and health plans (22%). The public cited the cost of health care (38%) and cost of prescription drugs (31%) as the top problems facing health care and medicine.
Preventing Medical Errors?
Doctors and the public differ in their views of the most effective ways of reducing medical errors. Much of the public agreed that nine of the 16 offered proposals could be very effective, but a majority of practicing physicians saw just two proposals as very effective: requiring hospitals to develop systems to avoid medical errors (55%) and increasing the number of hospital nurses (51%).
Physicians and the public disagree substantially in their views on some of the key proposals:
— Seven in 10 of the public (71%) said requiring hospitals to report
errors to a state agency would be very effective, compared with 23% of
physicians.
— A majority of the public (62%) said reports of serious errors should be
released publicly; just 14% of physicians agreed, with most doctors
(86%) saying hospital reports should remain confidential.
— Half of the public (50%), but only 3% of physicians, said that
suspending the licenses of health professionals who make medical errors
would be a very effective solution for reducing errors.
— Two-thirds of the public said it would be very effective to reduce the
work hours of physicians in training (66%) compared to 33% of
physicians.
Although few physicians said that more malpractice suits could be effective in preventing individual errors, a majority believes that surgeons who make errors with serious consequences should be subject to lawsuits.
Gap Between Medical Error Experts and Views of Physicians and the Public
Physicians and the public do not necessarily agree with the views of experts regarding the effectiveness of certain approaches to reducing errors. For example, less than a majority of both physicians and the public believes that limiting certain high-risk procedures to high volume centers (40% of physicians, 45% of public), increasing use of computerized medical records (19% and 46%, respectively), or use of computers in ordering of medical tests and drugs (23% and 45%, respectively) would be very effective solutions.
Furthermore, about one-third of physicians (34%) agree that another key proposal of experts — using only physicians trained in intensive care medicine in hospital ICUs — would be very effective.
Causes of Medical Error
Physicians said the leading causes of errors are a shortage of nurses (53%) and overwork, stress or fatigue of health professionals (50%). A majority of the public identified seven causes; the top four they cited are physicians not having enough time with patients (72%); overwork, stress or fatigue of health professionals (70%), health professionals not working together or communicating as a team (67%) and a shortage of nurses (65%).
About seven in 10 physicians thought an error would be more likely at a hospital that does fewer procedures. The public was less sure, with about half saying that an error would be more likely at a low-volume center and the other half saying that errors would be more likely at a high-volume center (23%) or that volume would make no difference (26%).
Methodology
The Harvard School of Public Health and Henry J. Kaiser Family Foundation’s Medical Errors: Practicing Physician and Public Views is based on two surveys, one of physicians and one of the public, both designed and analyzed by a team of researchers from Harvard School of Public Health and the Kaiser Family Foundation.
Physician Survey
The fieldwork for the survey of physicians was conducted April 24-July 22, 2002 by mail or online with 831 physicians by Harris Interactive, Inc. The sample was drawn from the national list of physicians provided by Medical Marketing Service, Inc. This list includes both American Medical Association members and non-members and is updated weekly. The margin of sampling error was +/-3.5 percentage points.
General public sample
The survey of the public was conducted by telephone April 11- June 11, 2002 with a nationally representative sample of 1,207 adults 18 years and older. The fieldwork for the survey was conducted in Spanish and English by ICR/International Communications Research. The margin of sampling error was +/-2.6 percentage points.
Please note that for both surveys sampling error may be larger for other subgroups and that sampling error is only one of many potential sources of error in these or any other public opinion poll.