Docs Aren't All Bad

The Washington Monthly's Kevin Drum in his blog post a few days ago picked up on an important error in reports (including mine) that alleged nearly half of physicians failed to report medical errors. In fact, only 40 percent of physicians knew about serious medical errors committed by their colleagues, according to a chart book put out by Columbia University's Institute for Medicine as a Profession, which sponsored the study. So if 46 percent failed to report errors in at least one instance, the total is closer to 18.4 percent of ALL physicians who failed to report a serious medical error.

It's an important distinction, and it's important to correct errors, including my own. But the fact remains that 92 percent of physicians believe they should report errors, which is as close to unanimous as you're going to get in a survey. Is there any reason to think the behavior in the 60 percent who did not witness errors would be any different than the ones who had? I think the authors of the study were trying to suggest that the nearly half who failed to report errors were suggestive as to how the profession as a whole would react if confronted with that situation.

The precise wording of the question, contained in Table 2 of "Professionalism in Medicine: Results of a National Survey of Physicians" by Eric G. Campbell et al in this week's Annals of Internal Medicine, reads:

In the last 3 years, have you had direct personal knowledge of a serious medical error in your hospital, group, or practice? If yes, how often did you report that error to a hospital, clinic, professional society, or other relevant authority? (1. Always, 2. Usually, 3. Sometimes, 4. Never).

In the report, they do not report the percent who answered "yes" to the first part of that question. They only report in Table 2 and in the discussion that 46 percent answered either 2, 3, or 4 to the second part, meaning that at least once they failed to report a serious medical error. The chart book, which accompanied the release of the study, on Slide 32, reports that 40 percent knew about serious medical errors. But is hard to know whether to trust the chart book, which appears to have been prepared by a public relations agency. That same slide also reports that just 31 percent failed to report serious medical errors, which is not the same as what was reported in Table 2.