1st Edition
Medical Error and Harm Understanding, Prevention, and Control
Recent debate over healthcare and its spiraling costs has brought medical error into the spotlight as an indicator of everything that is ineffective, inhumane, and wasteful about modern medicine. But while the tendency is to blame it all on human error, it is a much more complex problem that involves overburdened systems, constantly changing technology, increasing specialization, and a cycle of continual funding shortfalls made even more acute by resource-wasting inefficiencies.
Medical Error and Harm: Understanding, Prevention and Control, presents the work of long time physician and teacher Milos Jenicek, a pioneering expert on epidemiology, evidence-based medicine, and critical thinking and decision making in the health sciences. Providing an extraordinarily comprehensive overview of the subject that is as thorough and scientifically organized as it is accessible and free of rhetoric, Dr. Jenicek —
- Presents a short history of error in general across various domains of human activity and endeavor, including concepts, methodologies of study, and management applications
- Provides semantic and taxonomic classifications of challenges in medical error and harm, two distinct domains
- Explores approaches used to investigate and ameliorate challenges in medicine and other health sciences
- Explains why, when, and how studies and decisions regarding errors should be carried out, such as whether risk assessment should be undertaken in the diagnosis, treatment, or prognosis stage
- Covers essential strategies for mitigating errors in the broader framework of medical care, specifically in community medicine and public health
- Considers the ever-growing role of physicians in tort law and litigation
The book also discusses whether dealing with errors is a learned skill and looks at how much of the problem with medical error is caused by the medical community’s failure to teach, learn, and understand everything there is to know about medical error, including the often neglected importance of critical thinking skills. Understanding and correcting this shortfall is a primary responsibility of every health professional, one they can begin to realize with the study of these pages.
Putting medical error and harm in context. Reducing errors and harm in medicine; beyond the ‘oops!’ factor
Errors as part of advances in medicine
How can we look at and consider medical errors today
What is covered in this book
The view of medical error problem in the light of the recent experience
Medical error and patient safety
How this book might contribute to the present state of human error experience and patient safety
The valued legacy. Error and harm across general human experience in the non-medical domains. Welcome to lathology.
A brief history of the recent human error experience
Definition of human error and other related terms
Taxonomy of error
Cognition and cognitive process at the core of error, and of its understanding and control
Models of error, their development and contributing sites and entities in context
An epidemiological approach to the error problem human error domain through the eyes of medicine and epidemiology
Implications regarding the search for understanding, control and prevention of error today
Ensuing state of the human error domain today
Error and harm in the health sciences. Defining and classifying human error and its consequences in clinical and community settings
Overview of our today understanding of error today
Overview of approaches to error in medicine
Definition of medical error
Variables and their taxonomy in the medical error domain
Describing medical error and harm. Their occurrence and nature in clinical and community settings
Research, knowledge acquisition, and intervention strategies in the general error domain as viewed by a methodologically minded physician-epidemiologist
Descriptions of single cases, small sets of error cases and harm cases
Back to epidemiology: what happens now? Occurrence studies, descriptive
epidemiology, magnitude and distribution (‘in‘whom, where and when’) of the error and harm problem
How to describe and report the occurrence of medical error and harm; very brief
guidelines
Analyzing medical error and harm. Search for their causes and consequences
Searching for "new" (yet unknown) causes and consequences of medical error and harm; etiological research, analytical observational epidemiology
Challenge of deriving cause-effect relationships from one or very few past observations; a priori causal attribution
Off beat searches for causes; siding with mainstream epidemiological experience
"Experimental" demonstration of medical error and harem causes and its compromises and alternatives
Is the mainstream epidemiological methodology of causal research feasible in the domain of medical error and harm?
Flaws in operator’s reasoning and decision making before action
Note about medical error and medical harm
System error vs. individual human error
Reminder regarding some fundamental considerations
Flawed argumentation and reasoning as sites and generators of error and harm argumentation and human error and harm analysis from a logical perspective
Where and when errors occur. Cognitive pathways as sites of error
Prevention, intervention and control of medical error and harm. Clinical epidemiological considerations of actions and their evaluation
Basic definitions, concepts and strategies of intervention in lathology
Basic angles of evaluation in lathology: Structure, process, outcomes, and other subjects to evaluate
What should be evaluated at the individual level: knowledge, attitudes, and skills
Experimental, quasi-experimental and non-experimental evaluation of interventions to understand and better control medical error and harm problems
Taking medical error and harm to court. Contributions of physicians and expectations of physicians in tort litigation and legal decision-making
Medical, surgical and public health malpractice claims and litigation
Language of medicine and law
General philosophy and strategies of medicine and law
The law process and its stages
Cause-effect relationships in medicine and law
Litigating the argumentative way
Disclosure of medical errors: Working in law and epidemiology with what is available
A difficult mix: medicine, ethics and law
Conclusions
Challenges in focus
Confounding error and harm
Persisting diversity of semantics and taxonomy
Lack of epidemiology
Dichotomy in lathology
Lack of training in lathology
Better knowledge, attitudes and skills in the management of error and harm
A need for better knowledge of cases of error and harm
Challenge of communication
Interaction between stakeholders in the error and harm domain in medicine
Psychological, social and legal challenges to perpetrators of error and creators of harm
Material gains and losses related to error and harm
Possible ethical challenges
Individual human error vs. system error
Lack of pragmatic choices regarding what to do in lathology
Unexpected roles, uses and potentials of logic, critical thinking and evidence in generating error management activities
Legal considerations
A Brief and (hopefully) Harmonized Glossary
Appendices
Biography
Milos Jenicek
… authored by a well-known physician and professor at the DeGroote School of Medicine in Ontario, Canada. Dr Jenicek begins with a review of human errors in general and then continues with a review of medical errors and the negative outcomes that follow … . The author reviews the history of medical errors and definitions by using an epidemiologic approach. He starts with a review of errors that cause traffic accidents and industrial injuries. … He also explores possible causes of medical errors, including human error or lapses in judgment and the rapid technologic growth currently observed in medicine, especially in the subspecialty areas. The author also presents numerous frameworks that can be used to identify the medical error type, possible causes, and various solutions. … Finally, he discusses medical-legal consequences of errors and how tort law has evolved over time.
—Shauna Ely Tarrac MSN, RN, CIC, CNOR, in the AORN Journal, April 2011Jenicek makes a valiant effort to impose some order on the diverse nomenclature of lathology and delves into the difficult task of taxonomy of this subject.
—John P. A. Ioannidis, in The Lancet
