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THE INSTITUTE OF MEDICINE: ITS WORK

LEE S. GOLDSMITH, M.D.J.D.

I recently attended the annual meeting of the American College of Legal Medicine. A featured speaker was Kenneth Shine, M.D., from the University of Texas, who was instrumental in the work of the Institute of Medicine and the continuing work to make medical care safer.

The earliest work of the Institute found that over 90,000 deaths a year were attributable to medical errors. Review of that work indicates that the number is probably considerably higher and does not include those who have been injured as a result of preventable actions. Dr. Shine indicated that the work that was done and continues to be done has changed systems and hospital operations. Notwithstanding this forward progress, not all hospitals and offices have adopted the recommended procedures which of course has resulted in the number of preventable injuries and deaths still not having reached acceptable levels.

The initial report was published in 1999 and now some 17 years later his degree of frustration was clearly visible during his presentation.

Three problems continue to be major concerns. First, the same injury occurring over and over again with different physicians causing the error. Here, when a new procedure is adopted there is a learning curve. Errors occur during the learning curve as physicians learn how to perform the procedure. It was determined after the fact that it took physicians about 35 operations before they learned how to put in the Kugel mesh. It is known that some 3000 law suits were filed. It is unknown how many patients were injured as a result of this learning curve. The institute is trying to identify problem procedures and make physicians aware of the problems so as to prevent injuries.

Second, it is known that the same physicians often cause problems over and over again. If a procedure is performed in a hospital the staff there may become aware of the individual practitioner's problems and take action but may not. Little is being done in this regard and patients are not properly protected. Surgical centers do not have the same safeguards as do hospitals and patient protection to the serial mal-practitioner is virtually non-existent.

Third, the performance of unnecessary and un-indicated procedures. There was the admission that nothing is being done in this regard.

Dr. Shine summarized his talk by giving the following advice: Be a proactive patient. Find out what you can about your doctor, procedure and medicine. Have a loved one, friend, companion go with you and be your advocate. Check on everything.

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