This commentary in the March 11, 2009, Journal of the American Medical Association, may not seem like one for a lay reader.

It is.

This one especially is for you if you are the one in your circle of family and friends who makes the decision about when to call the doctor—or even which doctor to call.

Much heartbreak is caused by a family member’s belief, accurate or inaccurate, that a doctor made an error which changed the outcome of the care for that patient or, worse, resulted in that patient’s preventable death.

Many lawsuits are filed, in part, because of these feelings. Many are justified. Many are not.  Lawsuits loom when doctors acknowledge error. Often, they dare not or face losing their malpractice insurance.

As the stakes—emotional, professional and financial—-are very high when an error is the topic at hand, it is important to understand what kind of error really matters?

All errors matter, if only as part of a doctor’s goal of doing things right.

The errors which matter most, though, result in harm to the patient. A patient whose cancer is found as soon as it is detectable has much better odds than a patient whose tumor is found one year later.

Nearly one decade ago, shock waves were felt throughout the world of health care when the prestigious Institute of Medicine (IOM), published a now-famous, and frequently cited, study, titled, “To Err is Human.”

That IOM study brought into the open the topic of medical errors.  The IOM study said that an estimated half of the medical care in the U.S. was not what was recommended for the problem.

This article reports on medical errors, their study and prevention today.

JAMA

“During the past decade, awareness and understanding of medical errors have expanded rapidly, with an energetic patient safety movement promoting safer health care through “systems” solutions. Efforts have focused on translating evidence into practice, mitigating hazards from therapies, and improving culture and communication. Diagnostic errors have received relatively little attention. Although the science of error measurement is underdeveloped, diagnostic errors are an important source of preventable harm.”

…”In considering diagnostic errors, it is important to distinguish between the error (a process) and the resulting harm (an outcome). Diagnostic error can be defined as a diagnosis that is missed, wrong, or delayed, as detected by some subsequent definitive test or finding. However, not all misdiagnoses result in harm, and harm may be due to either disease or intervention. Misdiagnosis-related harm can be defined as preventable harm that results from the delay or failure to treat a condition actually present (when the working diagnosis was wrong or unknown) or from treatment provided for a condition not actually present.”

“Because it is impossible to eliminate all diagnostic errors, open dialogue is necessary about how much diagnostic safety medicine can afford. Tort reform is needed to reduce excessive testing associated with the practice of “defensive medicine,” and defining acceptable error rates should be a policy imperative. These complexities notwithstanding, with nearly 10 years having passed since publication of To Err Is Human, there is cause for optimism that the next decade will see diagnostic errors “get the respect” they deserve. A scientific community is starting to form. In 2007, AHRQ announced a special emphasis on funding diagnostic errors research, and in 2008, the inaugural Diagnostic Error in Medicine conference was convened for investigators to share their work on misdiagnosis. With funding and collaboration, researchers are poised to increase the visibility of diagnostic errors and to advance the science of how to identify and prevent them. As with most scientific advances, this will likely be a long and arduous journey, but the next frontier for patient safety is in plain view.”

Citation:JAMA. 2009;301(10):1060-1062.