When Is an Error an Error?

Not so long ago, widely publicized reports put us on notice that when we get medical treatment, chances of a small screw-up–or worse–are far more likely than we would have believed.

This has put us on high alert. Now we're told by medical authorities (federal agencies, consumer groups, and even hospitals themselves) that we need to be our own health watchdogs, on guard and vigilant, sniffing out medication mishaps and other errors before they cause problems. If as patients we're too distracted, sedated, or cowed to be good observers, then family and friends are supposed to step in.

Trouble is, we may not be very good watchdogs. A study cited this week by the Commonwealth Fund, a public policy group that funded the work, shows that we're better at barking at squirrels scampering across the porch than we are at identifying bad guys.

For the study, which appeared in the Joint Commission Journal on Quality and Patient Safety, patients getting chemotherapy at a cancer center in Boston were asked whether they thought their recent care had been unsafe in any way. Of the 193 patients who agreed to be interviewed, 42 said yes and provided details.

When the researchers investigated, however, they found that nothing unsafe had happened to 29 of the 42 patients. The vast majority of the reports had to do with service-related complaints like long waits, lack of respect, poor communication, and parking problems.

To be sure, patients picked up a handful of genuine glitches–a painful IV that wasn't properly inserted, nausea following radiation therapy because an antinausea drug wasn't provided beforehand. And a couple of close calls unquestionably could have been serious. One patient's medical record, for example, didn't show that he was allergic to the blood thinner heparin, but he spotted the drug name on the IV bag and alerted the nurse before she started the drug. He was a good watchdog. But if these patients were typical, most of the rest of us will need a little schooling if we're going to bark every time we think there's a problem.