What are the 5 most common medical errors? And how can you reduce them?
Key points
- Memory
- Applying rules
- Communication (communication, communication)
- Knowledge/skills
- Bias.
Or .. as we say at MyHSN .. “MACK-B” errors occur .. so focus on preventing them
Oh yes. Frustratingly, most doctors peak at aged 50-55 years – yes, quite old. Irritating, isn’t it? You may be decades off that. Be patient and you will get there.
We will now go through the 5 most common medical errors in more detail – and how to reduce them.
1. Memory
- Incorrect memory regarding last case
- Simple lapse – e.g. forgetting to specify a maximum daily dose for an ‘as required’ drug.
How to reduce this error
If you have an area of your work where you just forget things, create something you can access quickly (e.g. a note on your phone, construct your own website or blog) where you know you can find the answers.
2. Applying rules
- Applying a bad rule – e.g. incorrect, ineffective or out-of-date guideline in operation
- Applying a good rule mistakenly – e.g. effective guideline misapplied such as over-adherence to guideline. They are only guidelines, i.e. for most patients most of time
- Organisational – e.g. pressure sore prevention.
How to reduce this error
You need to know the local and national guidelines that cover your work. You should apply these most of the time. Or if you are working outside them, know why you are doing that and consider informing the patient.
3. Communication (communication, communication). THE BIG ONE.
Poor communication is the most common cause of medical error. Full stop
It is especially common in junior staff who lack experience; and may have not yet learnt to be good communicators, and/or how their local health community communicates (especially between primary and secondary care).
- Communication – including documentation, follow-up not made (or made clear), or computers not talking to each other, difficulty in working out who to talk to (and how to talk to them)
- Administration – staff working with doctors may make communication mistakes (e.g. not listing you for an operation or procedure, or realise its urgency) – perhaps due to your poor communication
- Attention – being distracted ( e.g. writing diazepam for diltiazem).
Achieving these skills takes decades. You might as well start today. But it can be a long painful journey (sometimes literally) for you, the patient and loved ones. Inform your line manager about the error. Learn from it, try not do it again. Say sorry (early). Reflect in your e-portfolio. Improve.
But how?
Top Tip 1. Sit with good communicators. This is one of the best ways of improving your communication skills – take notes, use their phrases, body language and tricks of the trade
Top Tip 2. Communication skills courses – go on one. You can go to improve your skills. If you think you have a problem, definitely go on one. Volunteer before you are sent on one!
Top Tip 3. Do not blame the patient for the fact that NHS computers don’t link up. It’s your job to battle through and make things happen
Top Tip 4. Written complaint – if a patient makes one about you, this is:
- Serious – so take it seriously. Inform your line manager. It takes a lot of courage to write a complaint about a doctor (or other health professional). They are probably angry and it is usually due to ..
- Your poor communication skills
- They are usually right – well, 95%+ of the time
- A very good way of learning and improving.
Your response should be both F2F and written, and each should start with the “Sorry, and yes it was partly my fault .. ”
4. Knowledge/skills
This may also relate to lack of experience. A good example of this is a prescribing error.
- Prescribing errors – after communication, the commonest cause of error, e.g.
- Wrong dose or frequency of drug
- Wrong drug
- Known allergy
- Drug not given
- Writing illegibly is an error
- Wrong treatment (e.g. operation)
- Skills – technical, e.g. operation or procedural, or laboratory error
- Missing warning signs
- Being sent home from hospital too early.
How to reduce this error
This is a more technical skill. You either have these skills and knowledge or you don’t. Others will be better than you. Read alot. Read journals and books, go on courses, go to conferences regularly.
If the skill is prescribing, learn from good prescribers. Look drugs up, especially new ones to you
Whatever the knowledge/skill .. practice (practice practice) and you will improve.
5. Bias
- Based on previous case(s), or what is common
- Over diagnostic certainty (arrogance). This can be a problem with very senior doctors that do not listen carefully enough to patients or colleagues, or keep up-to-date
- Not wide enough differential diagnosis; leading to too narrow treatment options (treatment should cover more than one disease, if diagnosis not certain) (arrogance)
- Fear of challenging seniors (too respectful), or not seeking advice (arrogance). It’s OK to ask a friend if you are not sure. In fact you should.
How to reduce this error
You need to be modest, and able to self-reflect all the time – asking yourself why is that your answer? Could you be wrong? Try looking at it from another angle. What happens if you either a. do the opposite or b. do nothing? Still unsure? Ask a colleague to see the patient (who has never seen the patient), coming from a non-biased view point.
Factors in errors and Swiss Cheese
These are common factors in any of the errors above.
- Fatigue due to long duty hours
- Inadequate experience
- Inadequate supervision
- Complex case (including new disease)
- Negative emotional state (mood etc). A doctor can only be effective they are physically, mentally and emotionally well. If you are not, ask yourself why are you at work, and how am I fixing it?
Adverse outcomes from errors usually do not happen because of a single isolated error (e.g. one of the above), but usually reflect more than one happening at once, or a ‘system problem’. This concept is often referred to as the ‘Swiss Cheese’ model. But there is alot you can do to spot the holes lining up in the cheese.
MyHSN Mantra 1 – You need to make errors
If you have not made many mistakes, you have not seen enough patients, and taken enough controlled risks in unwell patients. You need to see more patients, on the wards, clinics, A&E, everywhere.”
This is one of the hardest lessons a a good doctor has to learn – sometimes the hard way. This is our mantra to reduce errors. Yes those errors will stay on your conscience. It is the burden a doctor carries.
If you have not made many mistakes, you have not seen enough patients, and taken enough controlled risks in unwell patients. You need to see more patients, on the wards, clinics, A&E, everywhere
MyHSN’s Mantra 2 (especially related to reducing errors)
Work very hard and enjoy it, or you will not get enough experience to be a good
(or one day great) doctor, and reduce your errors
Be kind and caring
Show that you care (make written records of that, yes, its possible).
And remember its about them.”
.. remember people will usually forgive you if you work hard, show that you care and say sorry.
Oh yes
If an error is made by someone junior to you in your team, its YOUR fault. You did not supervise them sufficiently. Sort it out and take one for the team. Protect the junior.
Summary
We have described what are the 5 most common medical errors; and explained how can you reduce them. We hope you understand them better now, and so can reduce yours.
Other resources
This is a US study of medical errors. This page is linked to another on things you can do to help your doctors reduce errors.
