'Blame and shame' culture perpetuates medical errors

March 16, 2000

Let's talk about error

Safe health care: are we up to it?

Medical error: the second victim

As long as medicine continues to foster a "blame and shame culture", underpinned by fear of litigation and by doctors themselves, mistakes will keep on happening, argue several of the editorial writers in this week's issue of the BMJ. Both doctors and patients have colluded to create an impossible expectation of perfection, they say, which makes it impossible to admit mistakes, let alone learn from them and prevent them happening again.

"We don't talk much about errors because deep down we believe that individual diligence should prevent errors, and so the very existence of error damages our professional self image", writes James Reinertsen, chief executive of CareGroup and Beth Israel Deaconess Medical Center, Boston. But most errors are inbuilt in the system and "waiting to happen", he says.

Guest editors of this week's issue, Lucian Leape, of Harvard University's School of Public Health, and Donald Berwick, of Boston's Institute for Healthcare Improvement, agree that doctors have been "shackled" by a culture of blame and guilt. This, they say, disallows safety issues the importance they deserve - despite three decades of accumulating evidence. They point out that not only processes but also conditions, such as hours and workload, need to be re-examined. Change is long overdue and must be driven by the profession itself, they write. "Patient safety depends on an open and non-punitive environment where information is freely shared and responsibility broadly accepted."

Albert Wu, of the School of Hygiene and Public Health at Johns Hopkins University, Baltimore, describes how doctors become the second victims of their mistakes through the subsequent isolation and fear of reprisal they suffer. "You feel singled out and exposed...You agonise about what to do...You know you should confess but dread the prospect of potential punishment and of the patient's anger."

Dr James Reinertsen, chief executive officer, CareGroup and Beth Israel Deaconess Medical Center, Boston, Massachutsetts, USA Email: jreinert@caregroup.harvard.edu

Professor Lucian Leape, Harvard School of Public Health, Harvard University, Boston Email: leape@hsph.harvard.edu


Dr Donald Berwick, Institute for HealthCare Improvement Boston Email: dberwick@ihi.org

Associate Professor Albert Wu, School of Hygiene and Public Health and School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA Email: awu@jhsph.edu


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