Errors, medicine and the law.

This is a timely book. The term ‘medical error’ appears in the media virtually every day. In this book, the authors gently tease out the layers of that simple term ‘error’ to reveal the complex nature of what lies beneath the surface. As humans extend the boundaries of possibility and medical technology advances, this leads to public expectation of near infallibility. In a consumer society, people are less willing to accept that an accident does not necessarily mean that it is someone's fault, whereas a more comprehensive approach would begin to identify other failures in a complex system. In the airline industry, a pilot who reports an error is immune from disciplinary action. At present, in most western medical systems, the reverse would happen and the reporter would become a victim—as illustrated in the UK by the anaesthetist who first raised concerns over the mortality rates of two cardiac surgeons working at the Bristol Royal Infirmary. All doctors make slips or errors at some time in their working lives. Even the most conscientious doctors can make mistakes. The background to a medical mishap frequently is more complex than at first assumed and attempting to lay blame often fails both the doctor and the patient. The authors point out that allegations of medical ‘fault’ frequently are misplaced; there is often a failure to identify important lessons and a more inclusive approach would elicit problems in a complex system. The term ‘medical error’ covers a wide spectrum from matters of chance to deliberate/intentional errors implying culpability. There is a world of difference between an understandable mistake (prescribing β-blockers in asthma) and a deliberate violation (falsifying clinical records). The authors discuss the ways errors have been broken down into categories to enable a fuller understanding of the way they arise, how they can be understood in terms of cognitive psychology and how the study of complex systems can be used to minimize error potential and identify important lessons. Is working while fatigued or sleep-deprived an example of a violation in the system or the individual? Finally, they discuss assessing standards of care and responding to the needs of the injured, both patient and doctor—the latter frequently being overlooked. A thought-provoking book for anyone who is seeking a fuller understanding of the complexities of medical errors.