Do house officers learn from their mistakes?

Article Abstract:

Physicians inevitably make mistakes. They may be due to inadequate or incomplete knowledge or a lack of time. Physicians in training, house officers, may be more prone to mistakes because of inexperience, and may be more distressed by their mistakes because they are still learning. A questionnaire was answered by 114 house officers about serious mistakes they had made in the practice of medicine, and what the adverse effects were for the patient. The mistakes reported were divided into types of errors, including errors in diagnosis (33 percent), errors in evaluations and treatment (21 percent), errors in prescribing and dosing of drugs (29 percent), and faulty communication (5 percent). Adverse outcomes of these mistakes were reported in over 90 percent of cases, and included physical discomfort, emotional distress, additional therapy, additional procedures, prolonged hospital stays, and in 31 percent of cases, death. The house officers listed having too many other tasks, being too busy with other patients, and fatigue as the most common causes of their errors. Only 54 percent of the residents questioned reported discussing their mistakes with the attending physicians responsible for the patients, and only 24 percent reported discussing these errors with the patients or their families. Most of the house officers were willing to accept responsibility for their mistakes, but most also suffered significant emotional distress as a result of having made errors. Many took constructive steps to change their practice, such as seeking more advice when unsure or reading or asking for references. The results of the questionnaire indicate a greater need for the senior physicians responsible for supervising the residents to be more available for consultation and advice. The results also suggest that more attention be paid to the delicate issue of informing the patient or his family of mistakes, which legal and ethical scholars agree is important. If residents can learn from their mistakes, patient care can only improve. (Consumer Summary produced by Reliance Medical Information, Inc.)

Officials and employees, Reports, Hospitals, Medical errors

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Socioeconomic inequalities in health: no easy solution

Article Abstract:

Expanding health insurance coverage is not likely to reduce inequalities in health due to socioeconomic status (SES). SES is a known and strong predictor of illness and premature death. Three observations suggest that universal health coverage will not by itself correct SES-related inequalities. The first is that the same SES-health gradient that is found in the US exists even in countries where there is universal health coverage. The second is that there are SES-related health differences even at the highest level of the SES ladder. The third is that SES differences exist in all types of diseases, including those that can be treated and those that cannot. In addition, smoking rates, diet, exercise, exposure to crime and exposure to disease and cancer-causing organisms all vary with SES and influence health status. SES also affects how well patients utilize available services and adhere to treatment regimens.

Health aspects, Analysis, Planning, Medically uninsured persons, Health insurance, Health care reform, Social status

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Palliative sedation in dying patients: "We turn to it when everything else hasn't worked"

Article Abstract:

A case study is presented of a dying 49-year old woman with widely metastatic breast cancer, and suffering from uncontrollable pain and myoclonic spasms in spite of efficient palliative care. The various aspects of palliative sedation, which is administered as the last resort to provide relief, are described.

United States, Case studies, Palliative treatment, Palliative care, Breast cancer

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