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To the Editor: In the first several paragraphs of their article, Drs Zhan and Miller¹ used 4 apparently interchangeable phrases: "medical injuries," "adverse events," "quality gaps," and "incidences of concern." In their analysis, the authors similarly conflated incidents that most physicians consider inevitable in a percentage of cases (eg, surgical infection and transfusion reaction) with injuries that are the result of gross negligence, such as a hip fracture sustained when the patient is dropped or death when the wrong dose of a drug is given.

Arnold Blank, MD
Queens-Long Island Medical Group
Astoria, NY

1. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290:1868-1874. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:304.

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