Medicine is complex, and slip-ups inevitably occur. "Internal Bleeding," a book by two prominent internists, details some of the harrowing mix-ups that have occurred at their hospitals and ask, why do medical errors occur so often and how can we do better? Medical errors are one of the leading causes of death (the Institute of Medicine approximates the figure at 100,000 per year in the U.S.), but it is so commonplace and hidden that it escapes the public's imagination.
The stories in the book are frightening and instructive. A child is given what would have been a life-saving transplant, except that the blood type of the donor had not been checked against the patient. A patient undergoes the heart procedure another patient with a similar-sounding name was supposed to receive. At a major academic center, an elevator is shut down for maintenance, preventing the transfer of a critically-ill patient from the wards to the ICU. For each of these, the authors study the root causes--what was the accident chain that allowed this to occur, and where could it have been broken and the error prevented?
The authors' perspective is refreshing. Even the best-trained, most competent physicians commit errors. And even when a doctor commits an error, they don't necessary deserve blame and censure. More useful is to try to see how modifying the health-care delivery system could have avoided the error. The authors suggest we follow the model of aviation accident investigators of plane crashes, who look to see how modifying protocols or changing the plane can prevent a future crash.
I recommend the book to medical students, those interested in the issue of medical errors, and those interested in health-care delivery systems.
