Talk:Medical error

Good start, I would like to see a broader coverage of iatrogenic injuries, rather than the narrow focus the article has begun with (sort of restricted to IHI) , and, if you are agreeable, would like to help expand it. Of course, everything in it should stay- it's just that there's more to cover. :-) Nancy Sculerati MD 16:47, 9 February 2007 (CST)

Yes, please help expand it. I was just working from that good article I found. Lots of other useful things to be said. Fred Bauder 20:17, 9 February 2007 (CST)

It should be Medical errors, instead of the singular (that's how it's categorized in the medical literature), can you change it? I'm just learning. Nancy Sculerati MD 19:21, 9 February 2007 (CST)

The Wikipedia convention is to avoid the plural, not sure what the policy is here. To change the name just "move" it. Fred Bauder 20:17, 9 February 2007 (CST)

I also wondered if you can change articles. Do you "move" them? how does that work? Create medical articles, move the information, then make medical article a redirect? How do you make a redirect by the way? and then, after you make a redirect, how do you access the page if you need to edit the redirect to become a list of options to chose from? -Tom Kelly (Talk) 19:36, 9 February 2007 (CST)

When you move the page, the original page becomes a redirect. Coding for a redirect looks like this: #REDIRECT [[New name of page]]. After you make a redirect, going to the old page forwards you to the new page which contains a link at the top to the old page, allowing you to access the old page for editing. You can then made it into a disambiguation page with multiple links, if you wish. Fred Bauder 20:17, 9 February 2007 (CST)

It's not a Citizendium convention- it's the National Library of Medicine- Medline. Medical Errors' Database: Ovid MEDLINE(R) Nancy Sculerati MD 21:19, 9 February 2007 (CST)

Redirected Medical error -> Medical errors, copied discussion

I made the move for the article, but had to do the talk page manually. Am I missing something? Nancy Sculerati MD 21:52, 9 February 2007 (CST)

I think the talk page should automatically move when you move the article. Fred Bauder 23:12, 9 February 2007 (CST)

At Talk:Medical error you had put nowiki tags before and after the redirect code which tells the code to not work. Fred Bauder 23:16, 9 February 2007 (CST)

Malpractice

"In theory, if all caregivers performed within the bounds of professional XXX, the incidence of medical malpractice could be reduced to zero." The standard measure is "accepted standards of practice in the medical community." This standard of negligence can limit the scope of malpractice to instances of failing to do what is usually done. Framing the issue in terms of error expands the scope of the field to include examination of what might be done to improve on what is usually done. Fred Bauder 09:33, 10 February 2007 (CST)

Encyclopedic error

The sort of analysis involved here could be generalized and applied to errors and shortcomings in encyclopedia articles, both here and in other venues. Fred Bauder 09:37, 10 February 2007 (CST)

That is a valid point. The encyclopaedia depends much on every item being right, from the start, instead of trying to fix a cumulative mess later on. In anaesthesiology, the talk for years has been about ARCS (Anaesthesia-Related Critical Incidents), the idea being that it is a series of incidents ("small", non-dangerous events that deviate from that which is defined as acceptable) which, when not detected and corrected, causes an error (that which is plain wrong), which is more difficult to manage, leading to complications and harm (fortunately this does not always follow from error). The idea is that one should be eliminating ARCS, rather than worrying only about reversing eventual complications. The correspondence to aviation is striking, nothing new, and likely to be related - I do not know for sure. I do know that in 1983 I wrote a script for a training video for undergraduates that used precisely the pilot / anaesthesia comparison. Two sites that discuss the issue: The Swiss Critical Incidents in Anaesthesiology, and The Virtual Anaesthesia Textbook. The field is very wide, if one is going to include all medical errors, and one may have to break it up into different articles. At present I am sort of occupied with my own specific interests, but I will be back. --Christo Muller 15:51, 11 February 2007 (CST)

do not remove quotes, please

An edit was just made in which, probably inadvertently, quotes were removed from a line. The reference is still there. I put the quotes back, because otherwise, it's plagiarism. It's easy enouh to have a series of mistakes (speak of the devil!) and then have the next author remove the reference. We really have to work hard (vigilence!:-)) to avoid this. Nancy Sculerati MD 17:06, 11 February 2007 (CST)

As long as the reference is there, it is not plagiarism. Quotes signify the material was copied verbatim, which it wasn't. During a long course of editing, such as happens on Wikipedia where 500 or more edits can occur in a few months, references do become separated from the material they support, or they may remain after the material is no longer in the article. It is very difficult in the confusion to keep track of such things. Fred Bauder 09:28, 12 February 2007 (CST)

Tiny thing--I noticed an indentation problem halfway down the article...that would be a nonmedical error I guess. :-) --Larry Sanger 18:49, 11 February 2007 (CST)

Missing tag </blockquote> on the second block of quoted material. Fred Bauder 09:15, 12 February 2007 (CST)

Those two blocks that are quoted are quite extensive, but I think they originally came from IHI, not from the Infection Control Today. I'll look for the original source. Fred Bauder 09:28, 12 February 2007 (CST)

Found it on the IHI site. The quotes are quite extensive, and difficult to rephrase. The Terms of use on IHI.org are rather onerous. I would say they are fair use, but that kind of depends on what license you adopt. They might not be fair use for the extensive commercial distribution possible under the GFDL. Fred Bauder 10:02, 12 February 2007 (CST)

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Pointed out that complaint about removing quotes was not justified, it was a paraphrase rather than a quote. I went back and checked: The Helmreich BMJ article: Pilots and doctors operate in complex environments where teams interact with technology. In both domains, risk varies from low to high with threats coming from a variety of sources in the environment. Safety is paramount for both professions, but cost issues can influence the commitment of resources for safety efforts. Aircraft accidents are infrequent, highly visible, and often involve massive loss of life, resulting in exhaustive investigation into causal factors, public reports, and remedial action. Research by the National Aeronautics and Space Administration into aviation accidents has found that 70% involve human error.

My writing: One approach is to apply lessons from aviation, "plane crashes are often spectacular and well publicized, resulting sometimes in significant loss of life. Consequently all plane crashes and other serious incidents are exhaustively investigated and analyzed with respect to cause. On the other hand, most medical errors do not have the same spectacular effects, thus do not usually receive the same intense scrutiny and analysis." [2]

It's true. I just hope I didn't quote another source and mis-attribute it. Nancy Sculerati MD 20:57, 11 February 2007 (CST)

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First reference

Hi Frd, just got caught in an edit conflict _ hope I didn,t mess up your cite; I've been attempting to follow the nascent CZ Citation Help style in case you're curious about the logic.Gareth Leng 13:32, 16 February 2007 (CST)

I don't think that first reference is very useful. If it contains the information it is quoted from the second source. Also clicking on the link does not access the promised information. Fred Bauder 14:09, 16 February 2007 (CST)

This is going to be a very interesting article. These are just some reflections, not prescriptions: I think in the UK the Medical Defense Union publishes details of all cases of alleged medical negligence; I dont know if you plan to broach the issue of negligence vs error?

I think some examples of common errors are needed, but it could be hard to do this in a balanced way. There are always a number of cases of the wrong leg being amputated etc., but I guess usually it's not recognising symptoms or getting a drug dose wrong.

There are a nummber of 'food for thought' issues that could be covered -

• the Hippocratic oath (first do no harm);
• it's said by some that rates of unneccessary intervention are excessively high in part because of the fear of litigation for neglecting conditions that need it;
• history -19th century heroic medicine and its generally toxic cures;
• The issue of on-call hours for junior hospital doctors has been covered very extensively in the UK, it would be good to spell out examples of the hours worked.

Gareth Leng 17:13, 16 February 2007 (CST)

The physician's perspective

Added credit to WP per User_talk:Robert_Badgett#Medical_errors.Robert Badgett 07:29, 29 October 2007 (CDT)

Moral development

It is recognized that higher education has a favourable impact on moral development: university students tend to reason more in societal and principled terms when faced with ethical issues, and less in terms of self-interest or peer approval, the more they advance in their university curriculum. The medical curriculum is a notable exception to this rule.

I very seriously question a generalization that all university education, even at the undergraduate level, develops particular reasoning you describe, which could be called liberal or communitarian. When I was a sophomore, I went without sleep until I finished Atlas Shrugged. It took a few years of real-world experience to realize Objectivism was not a practical system, along with other flavors of anarcho-libertarianism. While, to borrow from 12-step terminology, I might call myself a Recovering Republican, I remember watching with horrified fascination as people I knew, either in college at the same time or a little afterwards, were being investigated for their involvement in Watergate.

My undergraduate work was fairly interdisciplinary, and there was much more ethical discussion among, say, the journalism majors than the chemistry majors.

Moving to the graduate level, if medicine is a notable exception, what, then, are the products of the schools of law and business? The current greed-driven meltdown in the financial markets is probably due to a number of people with postgraduate education, but very few in medicine.

Further, as opposed to law or business, medical school is regarded as undergraduate medical education; a medical degree alone will not let one practice in any industrialized country. Graduate medical education is extremely variable in the emphasis on ethical issues, both with specialties and specific faculty. It has been suggested that the difference between God and a surgeon is that God doesn't think he was a surgeon -- I teased my surgeon, after cardiac bypass, by sternly asking him about his board certification, as he was consistently empathetic, patient, and courteous.

Good places to find substantial discussion in ethics include GME programs in palliative medicine, oncology, pain management, neonatology, psychiatry, etc. I'd be less likely to expect it in orthopedics or pathology. Thinking of another specialty, live performance of the song "Working Where the Sun Don't Shine" at http://www.youtube.com/watch?v=_N0w2rORwSc; lyrics at http://f2.org/humour/songs/crs.html Howard C. Berkowitz

My "maitre à penser" or mentor is, as may you have guessed, from another generation: http://ca.youtube.com/watch?v=N26KWq7MmSc .

I find most of my inspiration in his keen analysis.

A lawyer friend of mine who decided not to practice expressed the same doubts when I informed him about the research on physician's underdeveloped moral acuteness.

I have to concede that, contrary to the CMAJ's suggestion, you're both right: doctors are generally not worse than "golden boys" and lawyers. Those 3 professions do hinder moral development (while others do the opposite). Let me unearth these references....

Pierre-Alain Gouanvic 22:45, 20 September 2008 (CDT)

Law school:

Behav Sci Law. 2004;22(2):261-86.

Does legal education have undermining effects on law students? Evaluating changes in motivation, values, and well-being. Sheldon KM, Krieger LS.

Pierre-Alain Gouanvic 22:21, 21 September 2008 (CDT)

Education (!!!)

Moral judgment differences in education and liberal arts majors: Cause for concern

WP Derryberry, T Wilson, H Snyder, B Barger - Journal of College and Character, 2005 Pierre-Alain Gouanvic 00:31, 22 September 2008 (CDT)

The basic assumption:

Moral Judgement Development in Higher Education: insights from the Defining Issues Test PM King, MJ Mayhew - Journal of Moral Education, 2002

"Findings suggest that dramatic gains in moral judgement are associated with collegiate participation, even after controlling for age and entering level of moral judgement."

Why Does College Promote Development in Moral Judgement? James R. Rest

Evidence is reviewed showing that college attendance is associated with development in moral judgement. Six interpretations of why college has this effect are discussed: (1) simple age/maturation; (2) socialization; (3) learning specific knowledge or skill; (4) generalized understanding; (5) intellectual stimulation; (6) self-selection. Findings from longitudinal, experimental, correlational, educational and life experience studies are used to evaluate the plausibility of each interpretation. The last three interpretations are favoured over the first three.

Pierre-Alain Gouanvic 22:56, 21 September 2008 (CDT)

Is the crux of this argument...

1. Graduates in a certain set of fields of study lack moral judgment
2. Education in certain fields improve moral judgments, for certain definitions of moral judgment (e.g., communitarian/liberal vs. libertarian)
3. It is unclear whether the improved or impaired moral judgment comes from people self-selecting that they want to be in a particular course of study, or that the teaching (or group dynamics) of a course of study improves (or lowers) moral judgment
4. There is little support for the general statement that education improves moral judgment; there is support that participation in certain fields of education, at certain levels of study, affects moral judgment

Hypothetically, how would students who have not yet entered a social work versus finance program compare in moral development? Howard C. Berkowitz 05:58, 22 September 2008 (CDT)

lesson from aviation

you mention it was tested with C/S and gen. Anes. but what was the outcome of the study. Just a one sentence summary would suffice. Tom Kelly 22:23, 20 September 2008 (CDT)

Other sources of medical error

I made this edit which is an example of how insurance compensation schemes, or other systemic factors may result in less than optimal outcomes. (And added the patient as an obvious source of error). One of the factors commonly cited as a source of error is less than optimal administration of hospitals. Insurance and other factors structuring the medical system are the same sort of factors. Structured badly enough they profoundly affect quality of care. This thought might be better expressed in an article on another topic, however. Fred Bauder 13:37, 9 May 2009 (UTC)