Facing up to medical error

Won't it be a terrible downer to have a whole issue devoted to medical error? Aren't doctors in Britain taking enough of a beating as it is? Are you really going to put a picture of a plane crash on the cover of the BMJ? These are reasonable questions, but we have no doubt that we are right to devote most of this BMJ to medical error and patient safety. It's essential that doctors, patients, and politicians worldwide grasp the scale of the problem. That is the first step on the long road to reducing errors in health care to the same low levels seen in other high risk enterprises—like aviation.

The debate in the United States has been kick started by a report from the Institute of Medicine (p 725). Roughly 100 000 Americans a year die from preventable errors in hospitals. The annual toll exceeds the combined number of deaths and injuries from motor and air crashes, suicides, falls, poisonings, and drownings (p 759). We have these data because of a major study undertaken in the United States in the 1980s. The one comparable study from another country, Australia, produced even higher rates of error (p 774). The BMJ argued 10 years ago that Britain needed a similar study and was roundly criticised by the president of a medical royal college for drawing the attention of the mass media to medical error.

The American report succeeded in getting the attention of most of the media and of the president, and we must be optimistic that the United States is embarked on a comprehensive response to the problem. Meanwhile, the British media have been concentrating on the tragic case of a man who died after having the wrong kidney removed. The easy, understandable, and completely wrong answer to such an incident is to blame those who made the mistake. In fact—as several articles in this issue make clear—the correct response is to redesign systems so that errors are acknowledged, detected, intercepted, and mitigated (p 768 and p 771). Leaders must recognise the problem (p 730), and we hope (perhaps vainly) that this BMJ may start the debate in Britain and other countries that is already happening in the United States.

This issue is a first for the BMJ in that none of the authors of the editorials are British (in fact they are all American) and three of the four major papers are from the United States. This happy state of affairs arises because the Americans lead the world in this important subject (as in so much else), but we are delighted that the leading world expert on human error—James Reason—is British and a contributor to our issue (p 768).