Toward a Theory of Medical Fallibility

N o species of fallibility is more important or less understood than fallibility in medical practice. The physician's propensity for damaging error is widely denied, perhaps because it is so intensely feared. Patients who suffer at the hands of their physicians often seek compensation by invoking the procedures of malpractice claims, and physicians view such claims as perhaps the only outcomes more earnestly to be avoided than even the damaging errors from which they presumably arise. Malpractice insurance rates soar, physicians strike, legislatures intervene, and, in the end, health care suffers from the absence of a clear understanding of what medical error is, how it arises, to what extent it is avoidable, when it is culpable, and what relationship it should bear to compensation for harm. It is to this cluster of questions that we direct our efforts. We seek to provide the basic outlines of a theory of medical fallibility. Such a theory, to be accepted as adequate, must account for certain basic data. Those data include the fact that medical error not only occurs, but seems unavoidable; that some medical error seems innocent even when severely damaging, whereas other medical error seems culpable; that the harm that results from medical error seems some-