More than one of five Americans report that they or a family member had experienced a medical or prescription drug error, according to a new report from The Commonwealth Fund. Based on respondents' evaluation of these errors, this translates into an estimated 8.1 million households nationally reporting a medical or prescription drug error which turned out to be a very serious problem. The report also reveals many missed opportunities, such as failure to get preventive services at recommended intervals and substandard care for chronic conditions, which translate into needless suffering, reduced quality of life, and higher long-term health care costs.
The report points to many difficulties with patient/physician interactions. One of four Americans who saw a doctor in the last two years did not follow the doctor's advice, often because they disagreed with it. One of seven Americans in fair or poor health reports being dissatisfied with their care. In addition, one of five adults reports communication problems with their physicians, such as not understanding information, not feeling they were listened to, or having questions they did not ask.
"Physicians are taught 'First, do no harm.' Yet the evidence shows that harm is widespread," said Karen Davis, president of The Commonwealth Fund. "U.S. medicine must commit itself to achieving higher, industry-standard levels of quality in patient safety, and that goal must extend to all aspects of medical care, in surgical suites, hospitals and nursing homes, physicians' offices, and pharmacies."
Room for Improvement: Patients Report on the Quality of Their Health Care, by Davis and colleagues at the Fund, is based on the Commonwealth Fund 2001 Health Care Quality Survey, which consisted of interviews with 6,722 adults conducted by Princeton Survey Research Associates.
Medical Errors May Be More
Widespread Than Previously Reported
One of five (22%) Americans report that they or a family member had experienced a medical error of some kind. One of ten adults reported that they or a family member had gotten sicker as a result of a mistake in a doctor's office or in the hospital, and about half of those said the problem was very serious. Of the 16% reporting a medication error, over one-fifth said the error turned out to be a very serious problem. Nationally, this translates into an estimated 22.8 million people reporting at least one family member who experienced a mistake, and 8.1 million households reporting at least one family member had a problem that was serious. This suggests that the Institute of Medicine's 1999 report To Err Is Human, which estimated that there are 44,000 to 98,000 deaths annually due to medical errors, may be just the tip of the iceberg in determining the full extent of injuries from medical errors.
Preventive and Chronic Care Lacking
The report documents serious underuse of preventive services and inadequate monitoring of chronic conditions. One of five women (20%) over 18 had failed to receive a Pap test in a three-year interval, one-fifth of adults had not had a cholesterol screening exam in the past five years, and nearly half (44%) of adults had not had an annual dental exam. The authors note that inadequate outreach and poor follow-up may be the cause of these low rates of preventive care. Another disturbing finding points to lack of monitoring of serious health problems. Nearly half (45%) of adults with diabetes reported they had not received three recommended annual checks (eye exam, foot exam, and blood pressure).
Many Physicians Are Not Meeting Patient Expectations
High-quality care means shared understanding between patient and doctor and an agreed-upon approach to addressing it, but the quality of patient-physician interactions is disturbingly low for many adults. Low income Americans, and those with less education, are particularly vulnerable to communication problems with their doctors. Three of ten (29%) of those who did not complete high school reported having a communication problem with their doctor, and even more surprising, one of six (17%) college graduates reported a communication problem. While just over half of all adults (57%) found it very easy to understand written materials from a doctor's office, only two of five (39%) adults with less than a high school education found materials very easy to understand.
Lack of understanding information is just one aspect of the communication problems that pervade doctor/patient relationships. Lack of agreement also appears to be a major problem in the health care setting. One of four adults who had a health care visit in the last two years said there was a time they did not follow a doctor's advice. Of those, two of five (39%) said the reason was they disagreed with the doctor, one-fourth said the advice was too costly (27%) or too difficult (26%) and one-fifth (20%) said the advice was against their personal beliefs. Just seven percent said they did not follow advice because they did not understand it.
"A good relationship between doctor and patient characterized by open and trusting communication is a critical component of high quality health care," said Stephen C. Schoenbaum, M.D., senior vice president at the Fund and a co-author of the report. "Physicians need to understand patients' concerns and circumstances, and patients must feel they have enough time to ask questions and reach agreement on the best course of care and treatment."
Part of the problem may be lack of continuity in the health care relationship. Only one-third (34%) of adults in the survey had the same physician for more than five years.
