A Self-Reflection by American Doctors

A patient is receiving an operation in the operation room for an hour. Doctors are opening the artery and put a tube into the heart. And then the phone rings. “What! Wrong patient?”

An operating room in another hospital. A 7 year-old girl is brought into the room. A doctor verifies the nametag on her wrist. And then he successfully finishes a tonsil excision and adenoids excision operation, which is to cut the tonsil and put a tube in her ear. And somebody yells after the recheck the patient’s name. “Oh, no! Wrong Patient!”

This is a real case story. The New York Times reported on the 18th that the biweekly journal of the American Internal Medicine, ‘the Internal Medicine Report’, started a series that introduced medical accidents that were caused by doctors’ outrageous mistakes and presented causes and solutions. ‘The Quality Grand Rounds’ is the title of this series. The purpose of this series is to introduce real absurd medical accidents and to analyze the causes so we can learn from the mistakes. Doctor Robert Waktor(University of California, College of Medicine), who are leading this project, said, “the same mistakes are repeated because of the habitual of the medical field to hide their mistakes,” and explained, “we have started to analyze mistakes to reduce them.” It is a kind of ‘self-examination’ of doctors.

Some absurd medical accidents such as cutting the wrong leg, operating the wrong side of the brain, and killing a cancer patient with excessive use of chemical treatment were often introduced. In 1999, a valvular operation patient and a pulmonary emphysema removal operation patient were mixed, and there was a case that the right eye was operated instead of the left eye in Japan. According to the American Medical Association, there are 44,000 to 98,000 killed annually because of those mistakes in America.

‘The Internal Medicine Report’ pointed out through analyzing the cases that the major causes of those medical accidents are miscommunication between doctors and nurses and ignorance of official work procedures. And it also pointed out that the negligence of managing the patients’ case history and inadequacy of the computer system are the other causes. This report also introduced that sometimes doctors and nurses made mistakes because they were hurrying to go home, and did not care urgent patients to catch a plane

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