Say cultural shift is needed: physician authors take on medical mistakes.(Practice Trends)

Dr. Robert M. Wachter transported a teenager to a pediatric intensive care unit in an ambulance without a cardiac monitor or a defibrillator. No one--not Dr. Wachter, the nurse, or the emergency room clerk who called in the transport request--had thought to specify a full-service "priority one" ambulance for the 10-mile trip.

Dr. Kaveh G. Shojania sent a 29-year-old man home from the emergency room with a prescription for codeine and a diagnosis of "rib trauma and gastritis" following a slip in the shower. Two days later, the patient was back in the hospital for an emergency cardiac catheterization. Dr. Shojania had missed a major heart attack.

"Our instinct at the time, like all doctors, was to blame ourselves after we screwed up," said Dr. Wachter, chief of the medical service at the University of California San Francisco (UCSF) Medical Center.

Today, the two physicians are taking a broader view, telling their stories--and far worse--in a new book, "Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes" (Rugged Land, 2004).

Terrible errors happen every day in the nation's health care system, according to the authors. They contend that mistakes are inevitable, and cannot be prevented without a cultural shift to an aviation-industry mindset that roots out and corrects all the causes behind an accident.

"We can't begin to fix this problem until we give ourselves a break, by recognizing that sometimes bad errors are committed by good, committed physicians. Fixing this problem will require a new approach," Dr, Wachter said.

Despite the furor over the 1999 Institute of Medicine report on medical errors, many physicians still have not come to grips with the need for systemic changes, he said. "You have to be open to the scope of the problem, and when you are, you recognize that we have become inured to and paralyzed by thinking of medical errors as collateral damage."