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Albert W. Wu, MD, MPH; Susan Folkman, PhD; Stephen J. McPhee, MD; Bernard Lo, MD

JAMA. 1991;265(16):2089-2094.

Abstract
Mistakes are inevitable in medicine. To learn how medical mistakes relate to subsequent changes in practice, we surveyed 254 internal medicine house officers. One hundred fourteen house officers (45%) completed an anonymous questionnaire describing their most significant mistake and their response to it. Mistakes included errors in diagnosis (33%), prescribing (29%), evaluation (21%), and communication (5%) and procedural complications (11%). Patients had serious adverse outcomes in 90% of the cases, including death in 31% of cases. Only 54% of house officers discussed the mistake with their attending physicians, and only 24% told the patients or families. House officers who accepted responsibility for the mistake and discussed it were more likely to report constructive changes in practice. Residents were less likely to make constructive changes if they attributed the mistake to job overload. They were more likely to report defensive changes if they felt the institution was judgmental. Decreasing the work load and closer supervision may help prevent mistakes. To promote learning, faculty should encourage house officers to accept responsibility and to discuss their mistakes.

(JAMA. 1991;265:2089-2094)

Author Affiliations
From the Department of Veterans Affairs (Dr Wu), the Robert Wood Johnson Clinical Scholars Program (Drs Wu and Lo), the Program in Medical Ethics (Dr Lo), the Center for AIDS Prevention Studies (Drs Folkman and Lo), the Division of General Internal Medicine (Drs McPhee and Lo), and the Department of Medicine (Drs Wu, Folkman, McPhee, and Lo), University of California, San Francisco.

Footnotes
Presented in part at the 13th annual meeting of the Society for General Internal Medicine, Arlington, Va, May 3, 1990.

Reprint requests to Johns Hopkins University, 624 N Broadway, Baltimore, MD 21205 (Dr Wu).

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