The Pharmaceutical Journal
Vol 269 No 7205 p33
6 July 2002

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Medical errors

'Errors, medicine and the law', by Alan Merry and Alexander McCall Smith. Pp vi+254. Price £17.95. Cambridge: Cambridge University Press; 2001. ISBN 0521 00088 2

This is a most timely book. It acknowledges that policy drivers to create a "no-blame" culture in the health service are not yet reflected in our legal system (nor, one could add, in the expectations of the public or the media). Written by a leading medico-legal academic and a New Zealand cardiac anaesthetist with special expertise in error reduction, the book provides a comprehensive account of the behavioural and legal approaches to medical errors and the inconsistencies between them.

Although some prior understanding of human error theory and the law of negligence will help, any pharmacist would find much to agree with in this commonsense analysis of human factors in accidents, errors and "violations" in health care practice and the unsatisfactory nature of "negligence" and its associated overtones of blame in dealing with them. Ample empirical evidence is given for truisms such as: culpability is not related to outcome; feeding back lists of frequent errors has no lasting effect on accuracy; fatigue is a frequent and overlooked cause of error; and violations often occur because of organisational targets or a culture that denies human weakness rather than because of personal recklessness or incompetence.

Although a damning critique is given of the inadequacies of using "super-experts" as witnesses to the standards that can be attained, every time, by the average overstretched, reasonably competent practitioner, the authors do not fully develop the risks inherent in the reporting of errors to a central audit. A blame-hungry media will surely demand disclosure and comparison of such data before too long and are unlikely to appreciate that, as the authors say, "the difficulty lies not in giving the right drug once, but rather in giving the right drug on every occasion, hundreds of thousands of times in a working life, often under circumstances which are far from ideal".

Joy Wingfield