Errors in medicine: The patient’s perspective

The first study of the patient’s perspective on errors in medicine may have health care professional rethinking what is important to their patients.

The study, published in the Annals of Family Medicine, suggests that patients are more disturbed with lack of access to and relationships with their physicians than technical errors in diagnosis and treatment.

Although much has been written about medical errors since the controversial To Err is Human: Building A Safer Health System was presented by the Institute of Medicine in 2001, a new study by Richard Frankel, Ph.D., research scientist at the Regenstrief Institute, Inc. and professor of medicine at the Indiana University School of Medicine and colleagues expands the dialogue to include the patient’s perspective.

“Much of the research on medical errors and patient safety has come from professionals speaking on behalf of patients. This study is unique because it focuses on learning from patients themselves what counts as an error. Importantly, many of the things patients consider as threats to safety, such things as racism, and discrimination based on age haven’t been part of the dialog in the research community about what increases or decreases risk. With this study we have the first steps toward a more comprehensive view of this territory.”

The study found that patients were more likely to report being harmed psychologically and emotionally than physically, suggesting that the current preoccupation of the patient safety movement with adverse drug events and surgical mishaps could overlook patient priorities. The researchers led by Dr. Frankel, who is a medical sociologist focusing on health care communication studied the perspectives of adults living in urban, suburban and rural settings who had recent outpatient contact with physicians.

Among the preventable problems in the process of care identified by the patients were:

• Difficulty contacting their physicians office and excessive time on hold.
• Intermediary or 3rd party imposed on communication with clinician
• Disrespect or insensitivity evident in interpersonal communication, rude behavior
• Patient opinion ignored
• Patient preferences not respected

The study found there was no apparent pattern with respect to the sex or specialty of the doctor, duration of physician-patient relationship, community type, state, form of health insurance, or the age, sex, or social economic status of the patient. However, African-American patients surveyed indicated a perception of apparent racism.