NOW THE WRONG QUESTION?

No one wants to make mistakes, least of all doctors whose mistakes may kill their patients. The classic paper by Wu et al¹ which is republished here shocked the medical establishment in 1991 by revealing how many doctors in training (interns and residents) were aware of having made serious mistakes in their first few years of hospital practice. Some of these probably led to the death of patients. The causes of the mistakes were often multiple and included lack of knowledge or experience, failure of supervision, faulty or delayed decision making, job overload, and fatigue.

Has anything changed in the decade or more since that paper was published? The study recommended that the underlying causes of error should be addressed: inexperienced trainees should be actively supervised by their seniors (especially in complex cases) and job overload should be tackled. The lot of the junior doctor has certainly changed. In Europe there has been a reduction in junior doctors’ hours of working and these will be further reduced with the European Working Time Directive. In the USA the US Accreditation Council for Graduate Medical Education has limited the hours of work for junior doctors to 80 per week from July 2003. In the UK this is 56 hours by 2004, reducing further by 2009. Doctors are now transferring to shift systems for emergency on call work, thereby reducing the actual length of time on call. This may reduce error by reducing sleep deprivation but, against this, it may increase the frequency of handovers, a risky process unless well managed. There tends to be more supervision by seniors or other members of the …