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. 2002 Jan 12;324(7329):109. doi: 10.1136/bmj.324.7329.109

Promoting patient safety in primary care

Honesty and openness may not be best policy

Graham Ness 1,2, Christopher Cordess 1,2
PMCID: PMC1121998  PMID: 11786460

Editor—We were both surprised by Wilson et al who, in their editorial, ask everybody to send in reports of their errors.1 Our concerns remain regardless of whether or not such accounts are published anonymously. After all, the police have used anonymous medical research data in their investigations. A conviction of culpable and reckless behaviour was secured against a man after he had sexual intercourse with his girlfriend without telling her he was infected with HIV. The scientific evidence that secured the conviction came from confidential research data that were obtained with a police warrant.2

Furthermore, Wilson et all say that for doctors to report their errors, patient consent will be needed. This means that the patient will know that an account of his or her care is to be published and may read it. He or she may ask his lawyers to read it. The lawyers may then be able to substantiate this published account as a confession of guilt or negligence.

Wherever and whoever we are, we must be careful as doctors what we say. For example, although we understand that no charges were brought, an incident last year highlights this point. Police are to hold a murder inquiry into the case of Peter Brand, a Member of Parliament for the Liberal Democrat Party for the Isle of Wight and a general practitioner, who mentioned during a parliamentary debate that he had withdrawn treatment from a two year old boy with leukaemia at the parents' request, to save him any more distress.3 This case had occurred in 1973, when he was a house officer.

However regrettable, we do live in a culture of blame. To admit professional mistakes of a minor nature may be straightforwardly forgivable. The admission, however, of a serious offence or negligence by doctors may result in litigation against them. Before discussing such matters in public, doctors should seriously consider whether honesty and openness are the best policy.

References

BMJ. 2002 Jan 12;324(7329):109.

Practices should set up their own critical incident reporting

Steve Ruffles 1

Editor—The editorial by Wilson et al on promoting patient safety in primary care serves as a prompt to develop appropriately designed incident reporting systems.1-1 The publication of Organisation with a Memory1-2 and Doing Less Harm1-3 and the recent launch of the National Patient Safety Agency have firmly set the agenda for risk management in both secondary and primary care.

Learning to identify and manage our risks in primary care could be seen as an opportunity to enhance and focus continuing professional development, team working, and cultural change. Cultural change should be characterised, in part, by risk awareness, openness, and the opportunity for anonymous and blame free risk and incident reporting within our organisations, by any team member.

Sheikh and Hurwitz have highlighted the importance of developing primary medical error databases.1-4 This should come from within the profession if we are to inculcate a sense of realism and ownership in practices in readiness for mandatory incident reporting.

In our practice colleagues and I have classified 25 types of adverse event. These include administrative and organisational, communication, and health and safety events and a range of clinical events (including diagnostic, therapeutic and prescribing, procedural, and case management “errors"). This is underpinned by a reporting system that takes account of the reporter's narrative and can be anonymous if required. Events are coded and stored on a secure computer, with the classified events recorded on dated spreadsheets with hyperlinks to the reporter's narrative, the analysis of root causes, and necessary actions as text files.

This will be enhanced by a more sophisticated database in due course, but this relatively simple approach has enabled us to get started by using our existing office software. This was relatively easy; the real work will lie in developing the culture and making the changes to reduce our risks and improve patient care. But if we can do it anyone can.

References

  • 1-1.Wilson T, Pringle M, Sheikh A. Promoting patient safety in primary care. BMJ. 2001;323:583–584. doi: 10.1136/bmj.323.7313.583. . (15 September.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Department of Health. Organisation with a memory. London: DoH; 2000. [Google Scholar]
  • 1-3.Department of Health; National Patient Safety Agency. Doing less harm. London: DoH; 2001. [Google Scholar]
  • 1-4.Sheikh A, Hurwitz B. Setting up a database of medical error in general practice: conceptual and methodological considerations. Br J Gen Pract. 2001;51:57–60. [PMC free article] [PubMed] [Google Scholar]

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