Many estimates put the number of preventable deaths due to medical errors around 100,000 people per year.  In recognition of that problem,  the Institute of Medicine, a private advisory group,  issued a highly influential report in 1999 titled “To Err Is Human”  to the public and Congress. It asserted that if the practice of medicine was made more systematic in all hospitals, the number of unnecessary deaths would be cut in half within five years. Both Congress and the hospital community embraced this philosophy, and have been operating under its principles for the past 15 years.

The problem with this thinking is that it is mistaken – most medical errors are made by individual human error, not systematic flaws. There have been a number of studies confirming that improved systems in hospitals have little impact on preventable fatal medical errors, including a recent study from Ontario, Canada, that concluded:  “implementation of surgical safety checklists in Ontario, Canada, was not associated with significant reductions in operative mortality or complications.” Other studies have drawn similar conclusions. A 2008 analysis of 10,000 surgical patients at the  University of South Florida  found that, of all the complications among those patients, only 4% were attributable to flawed systems.

The focus on systems meant that many researchers were ignoring another possible cause of fatal medical errors: incompetence by a small number of physicians. Dr. Robert Oshel, who was chief statistician for the National Practitioner Data Bank, examined medical malpractice suits nationwide and found that 2% of American doctors were responsible for 50% of the payouts over a 20-year period. And an Australian group examined 19,000 complaints against doctors over a 10-year period and found that 3% of Australia’s doctors accounted for 49% of complaints. Some staggering facts help explain the problem:

– The average American hospital revokes the privileges of one doctor every 20 years.

– Only 250, or 0.04%, of the nation’s 650,000 physicians lose their licenses annually. At that rate, it would take 50 years to remove the most dangerous 2% of doctors.

Perhaps the answer is not better systems, but better oversight, training, and discipline for the doctors committing the greatest numbers of errors.

Please read the LA Times for more details.