Medical Life

Two doctors write to upbraid me for my account of the Healthcare Commission's report on the state of the NHS, published last week, which noted that GPs are making "up to 600 errors" a day. Drs David Wheeler of Carlisle and Steven Ford of Haydon Bridge, Northumberland, protest that this is a tiny number, given there are 750,000 consultations a day.

"Considering that most of the stuff that comes through our doors is trivial or self-limiting, and all of it is unsorted, that strikes me as a fantastically good record. What other profession has an error rate of 0.8 per cent?" Dr Wheeler wrote to the Saturday edition of 'The Independent'.

While his maths is unimpeachable, unfortunately Dr Wheeler spectacularly misses the point. It is not that the number of daily errors is worryingly high, it is that it is too low. We know that errors happen, but they are not reported, and when they are not reported, they are much more likely to be repeated.

Errors, accidents and mistakes pose the biggest threat to patients in the NHS, and efforts to reduce them will save more lives than a whole bunch of miracle cures. Almost 3,500 NHS patients died last year as a result of errors, and more than 7,500 suffered serious harm, according to the National Patient Safety Agency – and those are just the ones we know about. But getting doctors and other staff to focus on them is fantastically difficult, involving a change of mind-set.

In 2007-8, almost one million incidents were reported across the NHS in which patients were put at risk, yet just 0.3 per cent of these reported incidents were from general practice, despite the fact that the largest number of consultations are with GPs. One in eight primary-care trusts did not report any safety incidents at all between April and June this year. Is that because there weren't any? Do pigs fly?

This is about the medical culture. Professionals raised in an era of unprecedented scientific progress have understandably tended to rely on technological advances such as antibiotics or newer devices and have perhaps forgotten about the basics, such as washing hands.

In modern medicine, where a new cancer drug that adds a single percentage point to the survival rate is hailed as a breakthrough, reducing mistakes is critical. John Naylor of Ashford, Middlesex put it well in yesterday's 'Independent': "If pilots could not do better than a 0.8 per cent error rate, I would never fly again; in fact, I would probably be dead."

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Pity that the film of the motor neurone disease sufferer Craig Ewert's assisted suicide at the Dignitas clinic in Switzerland was not seen by more people (it was transmitted on a new Sky cable channel). From what I have read, it conveyed the complexity of the issues better than much that has been written by learned commentators. I was struck by a comment he made after asking about the device that would switch off his oxygen supply. "Every day, you learn something new – even on the last day." Sounds like a good argument for keeping going.

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