When we think about medical errors and patient safety, we generally envision hospital disasters like cutting off the wrong leg in surgery or giving the wrong medicine in an IV that stops someone's heart. That's because, first, these are dramatic and unacceptable events, but also because almost all the research on patient safety has been done in inpatient hospital settings.
This is changing. A network of family doctors, sponsored by the American Academy of Family Physicians and the U.S. Agency for Healthcare Research and Quality, is bravely reporting on and analyzing medical errors in doctors' offices, and one of their recent studies focused on medical tests (Quality and Safety in Health Care 2008, volume 17, pages 194-200).
Medical tests include blood tests and imaging studies like X-rays, as well as Pap smears and other, more procedural tests. Errors can occur throughout the testing process: The wrong test can be ordered, the wrong test can be done, the results can get lost or misfiled, the doctor can misinterpret the test, not notify the patient of the results or give the wrong advice and so forth. This study looked at the whole continuum of testing and analyzed almost 1,000 errors in eight family medicine practices.
About a quarter of the errors were related to reporting test results to the doctor — they were incomplete, late or lost. The next two leading causes were errors in test implementation — the wrong test was done or the specimen was lost — and administrative errors, usually related to mistakes in filing the results or putting them into the patient's medical record. All together, these three kinds of problems accounted for more than 60 percent of the errors.
Now, most of the consequences of the errors were inefficiency and inconvenience: lost time, greater costs and delays in care that didn't affect the patient's health. But 18 percent of the errors led to physical or emotional harm, so there are important consequences to these mistakes. Doctors can use research like this to improve the systems in their practices so that the testing process is less likely to fail. Patients should take away from these studies the importance of being involved in their care.
Bottom line? When your doctor orders tests for you, make a note of which tests they are so that you can check that the correct test is being performed. And if you don't hear back from the office about the results, give them a call to follow up. Make sure that the right tests were done and that you know the results and what they mean for you and your health.
Family physician Douglas Kamerow, a former assistant surgeon general, is a researcher at Research Triangle Institute. He lives in Maryland.