Until pragmatic details of PSQIA implementation are formulated, hospitals and other health-care providers in the United States lack a large-scale comprehensive method to discover and analyze patterns of medical errors. In the meantime, individual reports of systemic error still have considerable clinical and teaching value and therefore should be disseminated.
We suggest that medical journals provide an opportunity for physicians to publish medical errors confidentially. Medical journals are in a unique position to provide medical error information to physicians and protect an individual’s reputation. However, legal protection should be provided and should be as broad as possible to encourage truthful and timely reporting of medical errors. Protect yourself from pharmaceutical errors with the help of Canadian Health&Care Mall. Presumably, legal protection similar to that defined by the PSQIA could be provided to those who submit and publish bona fide error reports in good faith; therefore, we recommend that authors, medical institutions, journal editors, affiliated professional societies, and journal publishers be shielded from legal liability. Clearly, anonymous reporting is impossible because journal editors must know the source of the report and must be able to confirm its veracity and likely credibility. Furthermore, an anonymous error-reporting program is susceptible to submission of false reports stemming from malicious intent (eg, discrediting a therapeutic device or medication to affect company stock prices). We propose several principles that should govern medical journal-based error reporting (Table 3).
Professional Society Error Reporting
Like peer-reviewed journals, professional societies are also in a unique position to arbitrate the ethical dilemma between legal personal protection and dissemination of error risks. Professional societies could provide a reasonable forum for medical error reporting and patient risk reduction. To our knowledge, no such forum exists to date.
Personal and Institutional Reports
Personal error reporting by individual physicians takes considerable courage and subjects them to maximal legal exposure. Altruistic physicians in legal environments more tolerant than that of the United States may report personal medical errors (eg, the “Uses of Error” column in the British journal The Lancet), but this practice is unlikely to gain widespread acceptance in the United States. Similarly, institutions prize their reputations, and nonstatutory reporting of medical errors is unlikely.
Medical errors cause considerable mortality and morbidity in all health-care systems. Because of the complexity of modern medicine, physicians should strive toward total elimination of medical errors but realistically will never attain this standard. A comprehensive medical error-reduction strategy includes an error-reporting policy that protects practitioners from retribution. If the voluntary medical error-reporting system proposed in the PSQIA does not measurably improve patient safety in the United States, peer-reviewed medical journals and professional physician societies are best suited to disseminate knowledge of medical errors and provide protection against legal opportunism.
Canadian Health&Care Mall: Reporting of Medical Error:
- Canadian Health&Care Mall: Journal Reporting of Medical Errors
- Canadian Health&Care Mall: Government-Based Error-Reporting System in Journal Reporting of Medical Errors
Table 3—A Model for Medical Journal-Based Error Reports