{'fraction_non_alphanumeric': 0.02291794556987927, 'fraction_numerical': 0.004910988336402701, 'mean_word_length': 5.331606217616581, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Errors Are Not Diseases: They Are Symptoms Of Diseases

When the Institute of Medicine (IOM) released its report, “To err is Human” in 2000, the reaction of most physicians was one of incredulity. The claim that more than a million patients were injured annually because of errors and upwards of 98,000 of these patients died did not square with the personal experience of many physicians. Subsequent studies, unfortunately, suggest the numbers may be considerably higher, including data from a survey of patients and physicians in which 42% of the public and 35% of physicians reported a personal experience with a serious medical error. Unfortunately the furor over the rates obscured the fundamental message from the IOM, which was that most errors result from defective systems, not careless or incompetent people. In fact, when they are investigated, adverse events in health care are invariably found to have multiple causes, and rarely—very rarely—is one of those causes malfeasance or incompetence of the person on the “sharp end” who got caught with the error. Like pain or fever, errors are not diseases; they are symptoms of diseases. The diseases are the inadequate systems we have created in our health care systems, such as the use of handwritten notes or prescriptions, having nurses measure out medications, and relying on our memories to avoid prescribing incorrect medications or operating on the wrong side. Like pain or fever, it is only when we investigate and discover the causes that we will succeed in eradicating the symptom. The IOM strongly recommended that health care providers adopt the “systems approach” to error prevention that has worked so well in other industries. Efforts to reduce medical errors that were already underway accelerated rapidly after the IOM report. At the national level, the Agency for Healthcare Research and Quality (AHRQ) has established a center for patient safety and quality that has generously funded patient safety research, convened educational conferences, and disseminated information to the public. The National Quality Forum came into being and has since identified and disseminated recommendations for reporting, quality indicators for hospitals, and a list of 30 evidence-based safe practices to be implemented as soon as possible. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has begun to require implementation of some of these, as have some payers. At the professional level, some medical specialties, notably anesthesia, emergency medicine, intensivists and hospitalists, have made significant progress. Anesthesia achieved dramatic reductions in complication and mortality rates in the ’80s and ’90s by implementing a variety of technical, procedural, and interpersonal systems changes. However, most surgeons in all types of fields have not been involved in these activities. Many have regarded safety and quality improvement as the province of others, except when it is forced on them, such as by the recent requirements from JCAHO regarding better procedures for preventing wrong site surgery, or the requirement by The Accreditation Council on Graduate Medical Education (ACGME)limiting resident work weeks to 80 hours. Not surprisingly, studies of surgical errors and adverse events are sparse. Thus the report by Shah et al. breaks important new ground in providing the first comprehensive look at serious misadventures in the practice of otorhinolaryngology. The authors carefully point out that neither the selection of respondents (voluntary) nor the method used to identify events (personal recollection) provides a valid or statistically representative sample from which to calculate meaningful rates of errors or adverse events. Nonetheless the data provide a rich array of actual events, all of consequence, encountered by practicing otorhinolaryngologists. This study does 3 important things: First, it provides a comprehensive look at the types of adverse events seen in otorhinolaryngology, both those in common with all of the practice of medicine (e.g., lost test results, administrative mishaps, adverse drug reactions, and wrong site surgery) and those unique to the specialty (particularly technical errors and some management mishaps). Not surprising, the largest category is technical errors, mistakes that are well understood and usually obvious. Second, it provides a unique and useful classification scheme that, to my knowledge, has not been used previously. Not only does this scheme make clinical sense, it would seem to have applicability to other surgical specialties. Third, based on the findings of the study, the authors are able to provide a useful list of 10 safety recommendations to reduce errors. One hopes that the findings concerning the severity of outcomes associated with technical errors in endoscopic sinus surgery and procedures involv-