•  
  •  
 

Abstract

In 2000, the infamous report To Err is Human rocked society with its focus on the pervasive danger of medical error. More than two decades later, medical error rates remain high and pose a consistent danger to patients. Today, medical error ranks as the fourth leading cause of death behind heart disease, cancer, and COVID-19. Medical error reflects the vulnerabilities of the healthcare process and may be diagnostic in nature. A large concern in responding to medical error is an overemphasis on blame and the idea that good physicians do not make mistakes. Our perspective on how to address medical error is flawed. The successful reduction of error will require rethinking how we respond to error and creating a culture of openness and transparency. Changing how we address error benefits all patients but is particularly important for racial and ethnic minorities, women, and the LGBTQ+ population, whose healthcare needs have historically been overlooked.

This Article reviews what we know about medical error and the disproportionate effects of harm it can cause. I consider issues leading to the persistence of medical error and emphasize the need to improve patient safety, address harm to vulnerable communities, and decrease medical malpractice litigation. Successfully addressing error requires a multi-pronged approach that embraces different disciplines. First, the healthcare industry should emphasize restorative justice strategies and institute legal safeguards, such as increased protections for apologies and information disclosure from healthcare institutions. Second, communication theory and high reliability organizations offer model methodologies to both address and prevent harm from medical error. Third, error response should shift away from a culture of blame and instead emphasize developing a Just Culture that encourages the acceptance of responsibility under collective accountability. Finally, the healthcare field should work to be more patient focused, with patients at the center of care and decision-making. Medical error presents a real and deep concern for patients and their families. Reducing the widespread effects of medical error will require a multidisciplinary approach extending to fields far beyond medicine, and even the law, to see real change.

Share

COinS