It's healthy to increase attention on medical errors

Oh, here's good news. There's a one-in-eight chance that if you go into a hospital some bad thing, or in technical terms an "adverse event," will happen to you there. What? You don't want to be told that? Would you rather it just quietly happened? I'm not being cynical. I'm delighted to read of this new study at The Ottawa Hospital of a small sample of patients. Obviously in the short run any publicity for medical errors is simply bad for the profession and I commend researchers and hospital administrators for letting it happen anyway. (As these terms are becoming more important, let me note that as far as I understand "iatrogenic" means all medically caused illness and "nosocomial" means specifically illness caused by hospitals.)

Remember that hospitals are dangerous places primarily because of why people go to them in the first place. The medical profession has long been mocked with terms like "sawbones" and "leech" by people well aware that not every visit to the doctor results in a cure. And I treasure the matter-of-fact tone of a 17th-century account ending: "they committed him to the Surgions to cure, in whose hands hee dyed a fewe dayes after." But in fact we should regard the successful rather than unsuccessful outcomes as remarkable. You're dying of pneumonia, you're absolutely toast, your relatives are quarrelling over your stuff, then the doctor gives you some pills and in a couple of weeks you're back on your feet wondering who swiped your CDs. Some people would be grateful for that.

When you go into a hospital, chances are you have something wrong with you that, if not treated, will cause short-term problems, long-term problems or possibly death-related issues. Sometimes even excellent treatment can't prevent such problems. Moreover, in going to a hospital you place yourself, of necessity, in close proximity to a lot of other people who also have things wrong with them, including infections. It is no reflection on the skill or dedication of medical professionals that sometimes these infections spread. But there are ways to make it less likely, not all of which are followed as thoroughly as they might be.

You might even have the impression from reading the papers that things are getting worse in this regard. Two stories about Montreal hospitals recalling patients for HIV tests (not what you're hoping for when you open the mail or answer the phone) followed nine stories in two months about Ontario hospitals reporting lapses in cleaning medical equipment. Does it seem that they didn't have stories like that when you were a child?

Do not delude yourself. They had the incidents. What's different is the stories, so let us be grateful for increasing attention to medical error.

It's partly due to the profession's continuous urge to improve. David Ropeik and George Gray's fascinating Risk: A Practical Guide notes that in the U.S. "a growing national movement is trying to create safer systems, based on the model of the aviation industry, which has demonstrated that such things as standardization, simplification, and use of protocols and checklists markedly reduce errors." I suspect Canadian hospitals are discovering weaknesses in their sterilization procedures precisely because they're developing such standardization and in the process finding gaps.

It's also because of growing awareness that in the face of antibiotic-resistant illnesses and emergent diseases science cannot be relied upon to produce a pill for every ill in a timely fashion. Instead, medicine must rediscover and is rediscovering old-fashioned barrier techniques. And some new-fangled barrier techniques, like a New York firm's device that uses fluorescent light to check whether people have washed their hands thoroughly. As the Citizen noted in reporting it, "Medical literature is full of studies showing that simple handwashing is one of the best ways to stop infection from spreading, yet many doctors and nurses don't wash enough." I suspect there will soon be similar-looking ultraviolet sterilization devices because, and only because, doctors are discovering the lapses.

Of course one of the thrills, and hazards, of research is that you never know what you will find until you look. For instance, that the recent Ottawa Hospital study found a rate of "adverse events" comparable to the apparent British rate of 10.8 and the Australian rate of 16.6, but way above the U.S. figure of between 2.5 and 3.7 per cent (Ropeik and Gray say between three and four per cent). Perhaps the American figures are too low, ours are too high or both. Or perhaps socialism is sloppy. More research is needed.

Of course the results might be unwelcome, even scary. But hey, better to know about it if it's happening. As with all forms of medical error. So hats off to the brave medical professionals who are helping us discover it.

[First published in the Ottawa Citizen]

ColumnsJohn Robson