Medical Error and Harm: Understanding, Prevention, and Control

Recent debate over healthcare and its spiraling costs has brought medical error into the spotlight as an indicator of everything that is ineffective, inhumane, and wasteful about modern medicine. But while the tendency is to blame it all on human error, it is a much more complex problem that involves overburdened systems, constantly changing technology, increasing specialization, and a cycle of continual funding shortfalls made even more acute by resource-wasting inefficiencies. Medical Error and Harm: Understanding, Prevention and Control,presents the work of long time physician and teacher Milos Jenicek, a pioneering expert on epidemiology, evidence-based medicine, and critical thinking and decision making in the health sciences. Providing an extraordinarily comprehensive overview of the subject that is as thorough and scientifically organized as it is accessible and free of rhetoric, Dr. Jenicek —


Presents a short history of error in general across various domains of human activity and endeavor, including concepts, methodologies of study, and management applications
Provides semantic and taxonomic classifications of challenges in medical error and harm, two distinct domains
Explores approaches used to investigate and ameliorate challenges in medicine and other health sciences
Explains why, when, and how studies and decisions regarding errors should be carried out, such as whether risk assessment should be undertaken in the diagnosis, treatment, or prognosis stage
Covers essential strategies for mitigating errors in the broader framework of medical care, specifically in community medicine and public health
Considers the ever-growing role of physicians in tort law and litigation


The book also discusses whether dealing with errors is a learned skill and looks at how much of the problem with medical error is caused by the medical community’s failure to teach, learn, and understand everything there is to know about medical error, including the often neglected importance of critical thinking skills. Understanding and correcting this shortfall is a primary responsibility of every health professional, one they can begin to realize with the study of these pages.

Putting medical error and harm in context. Reducing errors and harm in medicine; beyond the ‘oops!’ factorErrors as part of advances in medicineHow can we look at and consider medical errors todayWhat is covered in this bookThe view of medical error problem in the light of the recent experienceMedical error and patient safetyHow this book might contribute to the present state of human error experience and patient safetyThe valued legacy. Error and harm across general human experience in the non-medical domains. Welcome to lathology.A brief history of the recent human error experienceDefinition of human error and other related termsTaxonomy of errorCognition and cognitive process at the core of error, and of its understanding and controlModels of error, their development and contributing sites and entities in contextAn epidemiological approach to the error problem human error domain through the eyes of medicine and epidemiology Implications regarding the search for understanding, control and prevention of error todayEnsuing state of the human error domain today　Error and harm in the health sciences. Defining and classifying human error and its consequences in clinical and community settingsOverview of our today understanding of error todayOverview of approaches to error in medicineDefinition of medical errorVariables and their taxonomy in the medical error domain Describing medical error and harm. Their occurrence and nature in clinical and community settingsResearch, knowledge acquisition, and intervention strategies in the general error domain as viewed by a methodologically minded physician-epidemiologistDescriptions of single cases, small sets of error cases and harm cases Back to epidemiology: what happens now? Occurrence studies, descriptiveepidemiology, magnitude and distribution (‘in‘whom, where and when’) of the error and harm problemHow to describe and report the occurrence of medical error and harm; very briefguidelinesAnalyzing medical error and harm. Search for their causes and consequencesSearching for "new" (yet unknown) causes and consequences of medical error and harm; etiological research, analytical observational epidemiologyChallenge of deriving cause-effect relationships from one or very few past observations; a priori causal attributionOff beat searches for causes; siding with mainstream epidemiological experience"Experimental" demonstration of medical error and harem causes and its compromises and alternativesIs the mainstream epidemiological methodology of causal research feasible in the domain of medical error and harm?Flaws in operator’s reasoning and decision making before actionNote about medical error and medical harmSystem error vs. individual human errorReminder regarding some fundamental considerationsFlawed argumentation and reasoning as sites and generators of error and harm argumentation and human error and harm analysis from a logical perspectiveWhere and when errors occur. Cognitive pathways as sites of errorPrevention, intervention and control of medical error and harm. Clinical epidemiological considerations of actions and their evaluationBasic definitions, concepts and strategies of intervention in lathologyBasic angles of evaluation in lathology: Structure, process, outcomes, and other subjects to evaluate What should be evaluated at the individual level: knowledge, attitudes, and skillsExperimental, quasi-experimental and non-experimental evaluation of interventions to understand and better control medical error and harm problemsTaking medical error and harm to court. Contributions of physicians and expectations of physicians in tort litigation and legal decision-makingMedical, surgical and public health malpractice claims and litigationLanguage of medicine and lawGeneral philosophy and strategies of medicine and lawThe law process and its stagesCause-effect relationships in medicine and lawLitigating the argumentative wayDisclosure of medical errors: Working in law and epidemiology with what is availableA difficult mix: medicine, ethics and lawConclusionsChallenges in focusConfounding error and harmPersisting diversity of semantics and taxonomyLack of epidemiologyDichotomy in lathologyLack of training in lathologyBetter knowledge, attitudes and skills in the management of error and harmA need for better knowledge of cases of error and harmChallenge of communicationInteraction between stakeholders in the error and harm domain in medicinePsychological, social and legal challenges to perpetrators of error and creators of harmMaterial gains and losses related to error and harmPossible ethical challengesIndividual human error vs. system errorLack of pragmatic choices regarding what to do in lathologyUnexpected roles, uses and potentials of logic, critical thinking and evidence in generating error management activitiesLegal considerationsA Brief and (hopefully) Harmonized GlossaryAppendices