The professional activity of health workers is characterized by an increased risk. Hilfiker (1984) states that developments in modern medicine have provided doctors with more knowledge of the human body, more accurate methods of diagnosis, more sophisticated technology to help in examining and monitoring patients. All of that means more power to intervene in the disease process. However, modern medicine, with its invasive tests and potentially lethal drugs, has also given doctors the power to do more harm.
On the one hand, health workers risk their health and life, and on the other one, there is a risk of adverse outcomes of care for the patient, i.e. medical mistake. The physician assumes both moral and legal responsibility for the quality and consequences of his/ her actions in the process of patient care. Treatment failure may result in a medical mistake. The current research paper seeks to examine the core causes of the most common medical errors.
DeVita and Aulisio (2001) analyze the report on medical errors that are called To Err is Human: Building a Safer Health System. This report tells about 50, 000 deaths per year due to medical mistakes. It is evident that the problem of medical errors, as well as their causes, are extremely topical nowadays.
Indeed, there is no universally accepted definition of a medical error because this notion includes a plurality of components for all types of medical practice and legal liability. However, the medical error is treated as a discrepancy of diagnostic, therapeutic, preventive and other actions (or inactions) of the doctor (or complex medical services) concerning the patient. Lack of professional knowledge may lead to a deterioration of health or even death.
Edwin (2009) confirms a known truth, “…medical errors will likely continue as long as clinicians remain fallible humans”. Medical errors can be admitted at all stages of the relationship with the patient, in the process of care, which consists of the process of diagnosis, treatment, and other components of the entire spectrum of the physician-patient relationship.
Medical errors can be divided into deontological, diagnostic and therapeutic. The basis of deontological errors is a violation of the moral principles of a physician in relation to the patient, i.e. failure to comply with the ethics of medical practice.
The core reasons for diagnostic errors are: ignored or inept use of history as well as an incomplete examination of the patient. For example, erroneous interpretation of clinical data, erroneous assessment of radiological and laboratory investigations, carelessness and haste in the survey, wrong diagnosis formulation.
Therapeutic errors are associated with incorrect clinical diagnoses. As a consequence of such diagnoses, the patient is assigned to treatment that does not correspond to the true nature of the disease, and at the same time, the necessary therapy is not carried out.
Analyzing the causes of medical errors, one should say that duality and certain contradictions exist in relations between healthcare professionals and patients. On the one hand, health care providers must protect the interests of patients, but on the other, they also require protection from the patient, especially in cases of complaint or legal actions. This contradiction in all civilized countries is an inevitable accompaniment of modern medicine, new technologies, and the growth of the legal consciousness of the patients.
Along with the formation of civil relations between producers and consumers of health services, the law responsibility arises. What should be also noted about the medical errors is that it affects the physicians greatly. Boyle (2014) points out that errors are frequent in medicine and whenever a medical error occurs, the involved physicians struggle with the aftermath. Helping physicians deal with the emotional aspects of a medical error can help make medicine safer for everyone.
Doing his job, the physician is constantly at risk of being subjected to some sanctions. This is due to the fact that advances in medical science have led to unsustainable growth of expectations, which people put at the doctor, as well as a significant complication of medical technologies.
A medical error is an honest mistake of a physician, based on imperfect medical science and its methods, or the result of an atypical course of the disease or lack of training a doctor if this does not show the elements of negligence, carelessness or ignorance of health.
The causes of medical errors can be divided into subjective and objective ones. The subjective causes for medical errors are an under-or overestimation of clinical, laboratory and anamnesis data, low physician’s qualification, defective and (or) a belated examination of the patient, the underestimation of the severity of his/ her condition.
Subjective causes for medical errors include the largest group of errors which are caused by a lack of sufficient experience of the physician, but these errors cannot be qualified as ignorance. The subjective causes of medical errors are the following: defective inspection and examination of the patient, neglecting valuable methods for the study, the overconfidence of the physician as well as the refusal of the consultation. The use of outdated methods of diagnosis and treatment, blind faith in the all-new technologies, excessive faith in intuition, hasty, superficial examination of the patient, overreliance on surgical techniques, the desire to hide behind the authority of a physician consultant and neglecting the unusual symptoms are also the subjective causes of medical errors.
As for objective reasons, medical errors include a short stay of a patient in the clinic, the lack of material resources and medicines, late hospitalization of a patient, lack of knowledge about the nature of medicine in the pathological process.
Objective causes for medical mistakes are the following - rapid changes in health care systems and principles, changes in the interpretation of the etiology and pathogenesis of erroneous test results due to the violation of metrology and poor medical equipment. The lack of adequate or standard conditions and efficient organization of work for the examination and treatment of patients, etc., are also in a group of objective causes of medical errors. Most objective reasons are usually easy to identify and to warn.
It is important to understand how difficult the determining of the correct diagnosis and adequate treatment of a particular group of patients is when the doctor has to deal with cases of casuistry, an atypical course of the disease, and has not a sufficient time interval for diagnosis and so on. Therefore, in a doctor’s practice, even with a very conscientious attitude to work, a high level of qualification, the errors in diagnosis and treatment are possible. Null, Dean, Feldman, Rasio, and Smith (2003) analyzed American medicine from different points of view, especially from the ethical ones. They give an example that 12,000 deaths occur each year from unnecessary surgeries.
Physician’s activity from ancient times is quite strictly regulated by various social norms. Indeed, medical errors can be classified into:
- Failure to provide assistance to the patient by medical professionals, including unjustified refusal.
- Errors in diagnosis of diseases.
- Inadequate medical care.
- Violation of the patients’ rights.
- Failure to follow sanitary and epidemic regime.
- Violations of accounting, storage and use of medicines.
- Violation of safety.
- Abnormalities in the process of transporting patients.
As for the reasons for the increasing number of medical errors, it should be emphasized on the including of invasive technologies, the decline in the prestige of the medical profession, a lack of qualified medical personnel.
Moreover, one of the reasons for medical errors is the fact that the volume of medical information is so great that it cannot be known by one person, as the number of known diseases exceeds ten thousand. There exist more than one hundred of symptoms and syndromes as well as thousands of laboratory, cytological, biological, clinical and other diagnostic methods.
It is necessary to distinguish the error associated with the private omission, forgetfulness, underreporting of some information, ignorance about the drug, or an overestimation or the underestimation of the results of various studies, etc., from the rough irresponsibility, carelessness, negligence, and ignorance.
Most medical errors are related to insufficient knowledge of the subject. To a greater extent, it is because of completely new materials for diagnosis, treatment, and prevention. Further information on each discipline increased annually, new drugs are created as well as diagnostic, therapeutic and surgical techniques are improved. What is more, there is a development of new approaches to treatment strategy, and new directions in various medical disciplines.
In conclusion, it should be noted that speaking about the evaluation of medical errors by society, there exists a paradox. On the one hand, people believe that the doctor has no right to any mistake - neither small nor large, and on the other, everybody knows that only the person who does nothing, will not make the mistake. Hilfiker (1984) points out that mistakes seem different for doctors. This has to do with the very nature of our work. A mistake in the intensive care unit, in the emergency room, in the surgery suite, or at the sickbed is different from a mistake on the dock or at the typewriter. A doctor’s error can prolong illness, cause permanent disability, or kill a patient. Few other mistakes are more costly.
The main thing that should be known is that the ability to make mistakes is the natural characteristic of the human psyche. Recognizing this reality, one can see that the errors in medicine require maximum attention in order to reduce their number to a minimum.