In the September 2016 Monitor on Psychology, there was an article entitled “Medical Errors are the Third Leading Cause of Death in the United States.” My reaction was “WOW”; it’s hard to believe medical errors are responsible for more deaths than respiratory ailments, strokes, Alzheimer’s Disease and are only surpassed by heart disease and cancer. The first 2 are probably no surprise, but to see medical errors at #3 is shocking. Of course, as trial consultants, we have been involved in countless medical malpractice cases over the years, working for plaintiffs and defendants – never on the same case, of course. And, it is sobering to hear some of the stories we’ve heard and realize how dangerous it is to be sick and to be treated for those sicknesses. We know the vast majority of medical professionals do their jobs well; we also know there are many unforeseen consequences and that it is impossible to cure every injury, condition, or disease. As this article points out, there are many reasons for errors which lead to worsening a patient’s health condition or death. The article discusses the types of problems that lead to these errors – “problems related to teamwork, communication, technology design, leadership and human decision making…”. Regarding teamwork, the article quotes psychologist Dr. Eduardo Salas as saying “patient care is a team sport.” When the team does not play well together there are often problems. This is also true in other environments like flying a commercial aircraft. When the pilot and co-pilot are not functioning as a team, problems happen. The focus of the article is on the work of psychologists to identify problems, both at the detail level and at the big picture level, to try to reduce the errors. The good news is that, when put to the task of reducing errors, progress is being made by psychologists and others who study medical treatment, teamwork, processes, equipment design and installation, and the other factors which are common causes of these errors. Dr. Salas’ team has found, for example, that the 6 key ingredients of effective teamwork are: cooperation, coordination, shared cognitions (views of the patient’s situation), good communication protocols, mechanisms to resolve conflict and good leaders. These and other factors are leading to the implementation of programs for use in hospitals to improve patient outcomes. As a patient, one can and must, try to be involved in one’s care – or a family member should be involved. I have personally observed “near miss” or really “near hit” mistakes in helping with loved ones. So being on guard and observing is critical. For our clients who represent and defend hospitals, keeping up with the work being done on a big picture basis can help those hospital clients reduce errors and therefore litigation. For our plaintiff clients, reviewing scientific research can help explain where the chain broke causing the bad outcome. To read the full article go to Monitor on Psychology, September 2016, page 50.
Psychologists who have analyzed data from numerous adverse medical situations have identified 5 types of errors that cause medical mistakes: (1) errors of commission; (2) errors of omission; (3) errors of communication; (4) errors of context; and (5) diagnostic errors. The underlying problems that lead to medical errors have been studied by psychologists because many medical errors are psychological in origin, for example, poor communication among medical personnel; lack of teamwork; faulty leadership; and a disconnect between technology and its human users. Knowing the underlying causes of medical errors is, of course, the first step in establishing guidelines designed to prevent mistakes from being made. Based on my work on medical malpractice cases in my role as a psychologist who conducts litigation research, I believe poor communication and poor teamwork combine to cause the majority of medical mistakes that lead to lawsuits. I have worked on the gamut of medical malpractice cases, from wrongful deaths resulting from relatively simple surgical procedures to horrifying brain injuries in babies during the birth process. It has always astounded me when I realize that, if only ONE person on the medical team had performed his/her job properly, the medical error (or combination of several errors) would have been prevented and/or noticed before it was too late. However, people being people, physicians, nurses, and other health care staff make mistakes, fall into habitual ways of doing things, take shortcuts that negatively impact quality care, and engage in many other behaviors that compromise the well being of their patients. Everyone makes mistakes, however, mistakes made in the context of patient care often have dire consequences for the patient. Similarly, every profession has its above average, average, and below average performers and the medical profession is no exception to this rule. Attorneys who specialize in medical malpractice litigation are well advised to be informed about the latest psychological research pertaining to medical errors so that they are able to provide the best counsel to their clients, whether they are plaintiffs or defendants.
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