Medical Errors-causes,

consequences, emotional response

Many people are concerned about the possibility of a medical error in the current health
system. When medical treatments or healthcare services have an unexpected and unwanted
result, it is called an unfavorable event. This can be caused by a medical error when something
that was planned as part of a medical treatment is not finalized or the treatment has been
misused from the start.
Medical errors can occur anywhere: in hospitals, clinics, doctors' offices, pharmacies or even
at home. These may involve medication, surgery, diagnosis, medical equipment, or laboratory
analysis. It can happen even during routine activities, such as: a hospital patient who is
subjected to a salt-free diet is served a wrong menu.
Medical errors affect ten percent (10%) of patients around the world. Because one in ten
patients is the victim of medical errors.
In the United States, a recently released report showed that about 15,000 elderly people die
each month due to medical errors.
Most errors are generated by the current healthcare system, which is a very complex one.
Also, communication problems between physician and patient are an important cause. A
study shows that sometimes physicians do not help patients to get informed and make the
best decisions for them.
Thus, it is unlikely that uninformed and uninformed patients will accept the treatment
recommended by the physician and do what they need for that treatment to work.
Medical errors are one of the most common causes of death and medical accidents. Studies
show that there are more deaths due to medical errors than traffic accidents, breast cancer
or AIDS. There are many things that can be done in collaboration with your doctor to prevent
medical errors.
Errors are distributed in:

 Errors in fact;
 Legal errors (regular);
 in fact - due to the insufficient development of medicine (which is related to the
medical act, the nature of the work itself) does not attract the responsibility of the
medical frame;
  error of law (of the norm) -due to the lack of training and misconduct (which are
related to professional attitudes). , draws the responsibility of the medical
framework.

The mistake is human, man is subjected to error, and the physician is also a human being.
Here is a short series of banalities behind which lies our inability to avoid professional
mistakes.
A calculation error can lead to a financial catastrophe, and an error in address search can cause
a significant delay in the initial program. But a medical mistake can lead to the loss of human
lives and each of us has in his "record" mistakes of diagnosis, treatment errors or incorrect
interpretations of laboratory results.
The adjoining quote tries to highlight the absolute necessity of ensuring as a professional that
every step has been taken to avoid a mistake.
What needs to be done so that - in every case and in any situation - can we remain with the
consciousness of consciousness that we have done everything to avoid the error? As is always
the case, it is much easier to give advice than follow them strictly. However, I will try to briefly
build that puzzle that should fully embrace our system of thinking and acting on each patient,
especially in some critical situations.
Applying literature recommendations through professional and intellectual exertion ensures,
to a very significant degree, the correctness of the decision taken and has the effect of
avoiding the choice of a wrong track of diagnosis or treatment.
It is said that if all those well-informed would apply correctly and in any case the correct
proven recommendations, the number of medical errors would drop substantially.
And then, how is it explained in the United States that the number of patients who die annually
because of medical errors exceeds one hundred thousand? How can we explain the almost-
geometric progression of patient or inmate complaints against a bad result?
Without a doubt, one explanation is the lack of knowledge and / or incorrect application of
prescriptions included in guides and protocols. Ignorance and ignorance of these
recommendations often lead to negative results, and the process of detecting the error and
finding an unwanted result explanation becomes a relatively easy task for those who know
how to look for and find mistakes in our routine work (lawyers, judges , experts, etc.).
But even the fierce partisans of the importance of the recommendations in literature seem to
have to recognize an unpleasant reality, that even when the recommendations become a law
and are applied as such, they can not solve any case and their success does not, unfortunately,
90%. In other words, every tenth patient is in danger of not benefiting from the
recommendations of the literature, no matter how well they are applied.
But there is an aspect, sometimes neglected or even ignored: the obligation of each physician
to have clinical discernment - that intellectual procedure, which, relying on proven facts,
combines them with personal experience and unreasonable prescriptions and produces a
conclusion which suits a particular patient. And only him!
Because (we are again calling for the patrimony of medical banalities) we do not care for
illnesses but sick, and no patient resembles the other.
Compared to the rigor of literature recommendations, the call to clinical discernment can be
accompanied by many question marks, perfectly justified. But it is inconceivable that in those
cases where guides and protocols do not work, the doctor's obligation is to find alternatives
to improve the patient's situation. One of them is the call for a second consultation.
Applying the help of another doctor can induce, in a wholly erroneous way, the feeling of
personal failure, of inability to cope with a profession that belongs to you and who should find
the remedy in your knowledge of book and the experience accumulated over an entire career.
Nothing wrong! Because nobody has seen everything and nobody knows anything that could
happen to a patient.
Sometimes the opinion of another solves the dilemma, ease the way to making a decision, and
thus two goals are achieved: helping the patient in pain and reconciling the conscientious
doctor's conscience.
Using the most conservative estimates
presented in the article (0.6% of patients
admitted) and the data provided by
Eurostat in 2012, we get a total of 26137
avoidable deaths per year. It is double of
the following causes of death (liver
disease - 10975 annual deaths and lung
cancer 10332 annual deaths). As a
comparison, road accidents kill one-tenth
of people killed by medicine.
Certainly, no one is studying the faculty of
medicine to kill people. Medical error is
not something we want to happen.
But we're human. The system is created
by people. And then the system fails.
Whether cognitive errors occur, or
fatigue errors, wrong labels, loss of
communication between doctors, nurses,
pharmacists, etc. or simply because of
incompetence, medical error has
hundreds of causes.
The definitions of medical errors are subject to discussion because there are many types of
medical errors - from mild errors to serious errors - and causality is often poorly determined.
Health Grades, based on AHRQ (Agency for Healthcare Research and Quality) data, were based
on administrative data, not on clinical data, and rather omitted the multi-causality of the
results.
Medical errors can be:
o Diagnostic errors,
o Errors in medication (medication errors),
o Errors in the surgical performance of procedures, or in the use of other types
of therapy,
o Errors in the use of equipment,
o Errors in interpreting laboratory results

Risk factors involved in medical errors

Medical errors affect one in ten patients around the world. As a general rule, a medical error
occurs when a healthcare provider chooses an inappropriate method of care, or the health
care provider chooses the right care solution but does it incorrectly. Medical errors are often
described as human errors in the health care system.
Human error has been implicated in almost 80% of adverse events occurring in complex
sanitary systems. The vast majority of medical errors result from defective systems and badly
created processes versus inappropriate practices or incompetent physicians.
Medical errors are associated with the existence of doctors and nurses without experience
with the emergence of new procedures, age extremes, complex care and emergency care.
Insufficient communication (either in native language or, as may be the case for foreign
patients in another language), inappropriate documentation, indescribable writing,
inadequate patient-assisted reports, and similarly-named medications may contribute to
medical errors.
Patient actions can also contribute significantly to medical errors. Regressions, for example,
are often due to the wrong way of assessing patients.
Lack of sleep was also criticized as a factor contributing to the occurrence of medical errors.
An American study showed that internists who slept less than 24 hours doubled or tripled the
number of preventable medical errors, including those that resulted in injury or death.
In 2000, a study "To Err Is Human" was published by the Washington Institute of Medicine,
which states that the problem of medical errors is not the bad people in the health care system
- but the fact that good people work in bad systems that need to be made safer.
All medical errors are a major concern for patient safety. Those medical errors that are
considered "can be prevented" represent a continuous research area. This research is needed
because most of the medical errors are considered to be preventable.
The list of preventable medical errors include:

 surgical instruments forgotten during surgery,

 Surgery in the wrong place, inappropriate medication when ordering the right one, or
 Transplanting organs into the wrong blood group.

On the other hand, less obvious and more difficult to control medical errors include those
preventable errors that are illustrated in case study reports where one or more experts review
a physician's treatment decisions and conclude that the decision the doctor was incorrect.
Medical errors often occur in the treatment of mental illness. Those who suffer from
dysociative disorder of identity usually have a psychiatric history that contains three or more
mental disturbances and previous treatment failures. The disbelief of some doctors about the
validity of the disociative identity disorder may also add to the wrong diagnosis.
Studies have shown that:

 bipolar disorder was often misdiagnosed as major depression. The early diagnosis
makes the physicians look at the characteristics of the patient's depression and also
look after the current or previous hypomaniac or mania semiology.
 A common problem is also the misdiagnosis of schizophrenia. There may be long delays
until patients get a proper diagnosis of this disease.

Prevalence of Medical Errors

Despite outstanding advances in healthcare technology and services, too many patients die or
are injured as a consequence of medical errors.
A study focusing on hospitalizations between 2002-2004 in the United States showed that
approximately 83,000 preventable deaths occurred each year. Medical errors occur in
hospitals and other health care units, such as clinics, doctors 'offices, pharmacies, private
sanitariums, emergency centers, and patients' homes.
A British study published in 2002 suggests that one in five Americans (22%) reports that they,
or a member of their family, were dealing with a certain type of medical error.
The Office of the Veterans Inspector (VA) of the UK reported a total of 2027 medical errors
from June 1997 to December 1998, of which more than 700 resulted in accidental deaths or
suicide.
According to the Agency for Research and Quality of the European Health System (2002), it is
estimated that around 7,000 people die each year due to medication errors - about 16% more
deaths than the number attributed to workplace injuries (6000 deaths ).
The findings of the Washington Institute of Medicine (1999) show that in all hospitals in the
United States increased costs for preventable medical errors cost about $ 2 billion each year.
The extrapolated studies suggest that "180,000 people die each year, partly as a result of the
iatrogenic injury, the equivalent of three collisions of line planes every 2 days."
According to a 2005 study of 39 million patients, 241,280 deaths during hospitalization in a
US hospital were attributable to one or more preventable medical errors.
Every year, from 2001 to 2003, the study showed that the number of medical errors or
"patient safety incidents" in US hospitals was about 1.18 million, with a Medicare cost of
nearly $ 3 billion a year.
Sometimes there are difficulties in measuring the frequency of errors.
Approximately 1% of hospital admissions show an adverse event due to negligence. However,
mistakes are actually more common as these studies only identify mistakes that lead to
measurable adverse events occurring immediately after errors.
Independent examinations of doctors' treatment plans suggest that 14% of admissions can
benefit from improved decision-making. Many of the benefits would delay the manifestations.
Even this number may be an understatement.
A study suggests that in the United States, adults receive only 55% of the recommended care.
At the same time, a second study found that 30% of care in the United States may not be
necessary. For example, if a doctor fails to order a mammogram that should be done in the
past, this mistake will not occur in the first study. And because no adverse events occurred
during the short study follow-up, the mistake would not occur in the second study as only the
main treatment plans were criticized. However, the mistake would be recorded in the third
study. If a doctor recommends unnecessary treatment or testing, it may not appear in any of
the studies.

Causes of Medical Errors

 Inadequate or under-treatment, or inability to provide treatment.

 There may be errors in prescribing medication, or mistaken manipulation of
medication. There may be mistakes by medical personnel or a pharmacist to
administer the right medicines to the patient in the right amount.
 Additional work and fatigue of medical staff called to carry out extra tasks.
Nurses whose shift exceeds 12.5 hours have a three times higher tendency to make a medical
error than a nurse who works 8.5 hours or less. The error rate increases similarly after a nurse
is working more than 40 hours a week, regardless of shift times.

 The lack of several provisions or checkpoints in the sanitary system.

 Failure to monitor a patient
 Lack of preliminary agreement in writing
 Failure to prevent patient injury (eg falls) on medical unit property
  Failure to follow development directives. Inappropriate communication between
different healthcare providers or between providers and patients.
 Incorrect storage of medical files

According to the Agency for Research and Quality of the European Health System, some
medical errors of great importance, specific to the sub-specialties would be:

 Birth-related accidents (lack of oxygen is one of the major causes, and so is the
mechanical trauma, which can occur when the baby takes an unusual position during
delivery, or when the baby is too big to easily pass through the canal birth).
 Surgical complications
 Complications related to anesthesia, such as failure to administer anesthesia safely.

Patient Causes:

 lack of patience - It may be thought that it is the sick man - who suffers; but it is mostly
about patients with "administrative" problems (those who want a document, a
"stamp") and who once enter the office "forget" during the time of waiting patients.
 the patient is the patient who has "absolutely all rights" and who wants to impose
these rights in front of the doctor - whether they are immoral, illegal or often non-
medical.

EXAMPLES OF MEDICAL ERRORS

Stress among doctors
Physicians often meet people suffering from depressive syndromes or syndrome expressed
through mental exhaustion.
A study has attempted to confirm whether there is a link between the physician's stress level
and their work performance.
The study included 123 pediatricians, residents or specialists. Throughout the study,
physicians were monitored, 20% of physicians were depressed, and nearly three-quarters
(74%) suffered from burnout syndrome.
Conclusion: It has been confirmed that medical errors are quite common due to stress.

Ex. No.1: The doctors first reported that the President of Argentina has cancer.
The final histopathological analysis found the presence of nodules in the two lobes of the
thyroid gland but excluded the presence of cancer cells, thus altering the initial diagnosis.
Ex.No.2: Dead, but discharged
An even more interesting case has happened recently in Australia. Strangely or funny, a
patient was declared dead and was discharged after 12 hours.
In March, Peter was hospitalized for a day in the medical unit because of gastric problems.
Ignored by doctors, he discharged himself and went home.
Later, however, the man would find out, after a visit to his family doctor, that he had been
declared dead by hospital doctors.

Preventing Medical Errors

Involvement in the recommended treatment.
It is the most important way of preventing a medical error. This means that the patient
needs to be active and get involved in every decision related to his or her treatment.

Research shows that the results obtained by these patients are much better. Also, choosing
a physician with whom the patient feels comfortable, in which he is relaxed when discussing
his health, is a way of preventing.
Caregivers of a child or an elderly person must be actively involved in everything that means
medical treatment. Research shows that engagement can lead to good results and prevent
possible medical errors.

Prevention of medication errors

Reporting of all treatments followed. Not only prescriptions prescribed by a physician, but
also dietary supplements, vitamins or other herbal treatments will be considered. At least
once a year, you should talk to your family doctor about your medication. This is very helpful
to the doctor, helping him to keep up the medical record of each patient. Informing the
attending physician about all allergies or side effects that have been presented over time to
certain medicines. This helps avoid drugs that can harm you.

The prescription prescribed by the doctor must be decipherable. Otherwise, the physician
should be asked to explain the treatment schedule extensively in order to avoid possible
misunderstandings. The physician should be asked to give information about prescribed
treatments in terms understood by everyone. It is normal to ask questions and get answers
that we can understand.

The doctor should be asked to give information about prescribed treatments in terms
understood by everyone. It is normal to ask questions and get answers that we can
understand. Thus, it should be asked that:
 What is this treatment for?
 How to administer it & for how long?
 What side effects does have and what can they do if they persist?
 Can be combined with other treatments or supplements?
 Do food, beverages or physical activities be avoided during treatment?
When buying the drug from the pharmacy, the pharmacist should be asked if that is the
medicine prescribed by the doctor. It is very important to have the right medicine in the
correct doses. If the treatment spans over a longer period of time and it can be seen, at
some point, that the size, shape, color of the pills differs from what has been done before, it
has to be checked once again if the medicine has been taken properly.

There must be clarity about any blur with regard to the instructions on the label of the
medicine. Often, instructions can be hard to understand.
For example, it should be asked whether "four doses per day" means a dose every six hours
or just during the day at regular times.

The pharmacist should be asked which is the best way to measure liquid medications.
Advice should also be sought if it is not certain that the correct method of administration is
understood.
Research shows that many people do not know how to measure liquid medication, usually
using teaspoons of tea or coffee in the household.
Special measurement methods such as marked syringes help to make a correct
measurement, but guidance in doing so helps most.

Information about all side effects of drugs should be requested. If the patient knows what
might happen, he can be better prepared than if taken by surprise. Can immediately report
the issue and receive the necessary help in a timely manner. Written information can help
patients recognize the negative effects and then pass them on to the doctor or pharmacist.

Before taking a medicine, you should carefully read the label and all the written
recommendations. If the medicine looks different from what it is said, the pharmacist should
be asked.
If severe adverse effects are observed, contact a physician immediately. It can adjust the
dose to reduce or eliminate the negative effects or may recommend another medicine more
appropriate for the patient.

Other recommendations for preventing medical errors

 Would ask and talk to your doctor about any misconception that exists; the patient has
the right to ask for such clarifications to the medical staff involved in his / her care
 to make sure that the family doctor is aware of his / her state of health; this is very
important, especially when the patient has more health problems or is hospitalized
 must ensure that all physicians involved in the treatment are aware of all the health
problems that the patient has; this must not be presumed, but must be personally
informed
 Have a family member or friend ask a doctor if the health condition does not allow
them to do so personally; even if it is considered that no help is needed now, it may
still be needed later
 more does not always mean better; it is very good to inquire and try to learn as much
as possible about the treatment to be followed and how it will help
  if an analysis is to be made, it is not assumed that no news actually means good news;
they should be asked when the results are to be received, and if they are not received
at the right time, they are not supposed to be good; you need to call your doctor to
ask and ask for treatment clarifications
 it is good to ask for information on the treatment to be followed, both to the doctor
and other reliable sources; the doctor may ask if the treatment is based on the latest
research in the field.

Impact of involvement in medical errors on physicians

While many studies assessed the burden of adverse events in patients, the causes underlying
these events and interventions to increase safety, the impact of involvement in errors and
adverse events on health care professionals has gained far less attention in the public debate.
Though working conditions such as sleep deprivation and overwork have been discussed as
contributing factors professionals involved in medical errors have long been characterised as
“offenders”.
However, recent studies report that involvement in errors often results in serious health
effects, emotional distress, as well as performance and work-related consequences in staff
members,in particular physicians.
A number of qualitative and quantitative studies report that involvement in medical errors
often provokes intense emotional responses.
Common reactions reported by individuals involved in error include distress, self-doubt,
confusion, fear, remorse, guilt, feelings of failure and depression, anger, shame and
inadequacy that often persist for longer periods.
Both, poor patient outcomes and higher degrees of perceived personal responsibility seem to
amplify emotional distress .
In a qualitative study of needs and attitudes towards disclosure of errors both, patients and
physicians reported strong emotional reactions and had needs following errors, which were
not met . The severe emotional distress commonly reported by residents as a reaction to being
involved in errors may be explained by the perceived reasons underlying the errors .
In a survey among 1,318 registered physicians in Norway, 17% of those that had experienced
at least one adverse event with serious patient injury indicated that this event had a negative
impact on their private life, 11% reported that the event made it harder to work as physician,
and 6% needed professional help.
Recently, studies have become available that go far beyond investigating short-term
emotional disturbances as outcomes of error involvement.
These studies suggest that at least in a substantial fraction of physicians involved in medical
errors, serious health- and job related consequences have to be expected.
Being responsible for medical error can have a considerable impact on physicians. Many
professionals respond to error with serious emotional distress, and these emotions can
imprint a permanent emotional scar .
Involvement in error seems to considerably increase the risk for burnout and depression and
the evidence suggests a reciprocal cycle of these symptoms and future suboptimal patient
care and error.
Association of burn-out with medical errors has recently been confirmed in a prospective
study that used objective measures of error rather than self-reports .
Though in this study neither depression nor burn-out were associated with logged sleep hours
or work hours, the complex relationship between sleep-deprivation, mental health, and error
warrants further study.
Health care staff involved in errors find themselves in a conglomerate of individual values,
professional ethics and institutional culture, and working conditions that often perpetuate
uncertainty and isolation, and therefore hinders constructive approaches to the error
experience.
The evidence suggests that communication and interaction with colleagues and supervisors
are perceived as the most helpful resource by physicians.Still, for many residents
communication and support by their supervisors seems to occur rather at random, more or
less conditioned by the personality of the involved individuals, rather than systematically and
by institutional mechanisms, e.g., teaching physicians how to act as role models, or systematic
debriefing programmes for undergraduate students.
It is crucial to understand for supervisors, accepted clinical leaders and those engaged in
resident training that this support of staff needs to be proactive, as exemplified in the
statement of a resident in the interview study by Engel et al. : “… I was blessed with an
attending physician who was diligent enough, who forced me to talk about it. Otherwise I
would not have.”
Some authors suggest that talking openly with patients affected by errors may have “relieving”
effects to both parties and may not only fulfill the needs of patients but also help professionals
to cope .
Conversely, the study by Waterman et al. indicates that poor experiences with disclosure may
also increase stress in involved physicians. While there is not yet conclusive evidence on the
impact of error disclosure on staff, it may be required to accompany disclosure policies by
resources that enable staff to transfer these into daily practice and cope with negative
experiences.
Nearly every young women and every young man that start medical training today will be
involved in a serious medical error at some time in their career and will probably experience
strong emotional reactions to this fundamental event. It is a challenge and a matter of
accountability of the health care system as a whole and its clinical leaders in particular to
prepare them for this situation and to provide support to them when it occurs.