Medical errors are too common but patients are paving the way for change

By: Fiona MacDonald and Karine Levasseur

We have all been there: it is 3 a.m. and your partner, child, sibling or parent becomes ill suddenly and needs medical care. Will they be safe?  

The ongoing public inquiry into the safety and security of residents in the long-term care homes system is shedding new light on the employment history of an Ontario nurse whose career in long-term care ended after the murders of eight patients and attempted murder and/or assault of six more.

While the Elizabeth Wettlaufer case is an extreme example of what can go wrong in health care, it should also serve as a warning to all of us about the issue of patient safety.

The inquiry, which began last week, has already revealed new aspects of the case.

One such detail is that Wettlaufer had a history of medical errors that went largely ignored. This is an important fact not just in this case, but in understanding patient safety more generally.

Canadians have a high level of trust in their medical system. A 2011 EKOS research study suggested 81 per cent of respondents believed they would receive the appropriate care if they were to become seriously ill.

While these findings suggest the highest level of public confidence in over a decade, research also suggests that medical errors are a common phenomenon in Canadian medical systems.

A 2016 report from the Canadian Institute for Health Information concludes that for every 18 hospitalizations, one patient will experience harm that was preventable. Yet the true number of errors is difficult to track because most studies rely on medical records or critical incident reports. Many errors are not captured with this methodology since records are often incomplete or errors are not recognized as official critical incidents. 

In other words, the rates of medical harm may be much higher. 

While the numbers are disturbing, there are positive signs of change.

One important shift involves apology legislation that is now in place in most jurisdictions throughout Canada, including Manitoba.

Apology legislation gives medical professionals the opportunity to apologize for a medical error or mistreatment without fear of becoming legally liable. Apology legislation still allows patients to pursue a lawsuit if they choose, but it prevents people from using the apology as evidence of fault in a legal proceeding.

Reception of the legislation has been mixed, but numerous patient safety groups have heavily advocated for it.

With funding from the University of Manitoba and the Law Foundation of B.C., we are interviewing patients who have experienced medical errors or mistreatment to explore the impact medical apologies may have on those involved. Our research shows that medical errors are not unusual and that patients often hit a wall of denial when trying to hold clinicians accountable.

Many patients we have interviewed are now personally committed to promoting safe, high-quality health care. Some work with patient safety and quality organizations, some filed complaints with the College of Physicians and Surgeons, some wrote lengthy letters to administrators, and others personally met with clinicians and administrators to demand changes.

The Wettlaufer case demonstrates a complete breakdown in accountability that resulted in senseless and tragic loss. Records from the inquiry show Wettlaufer was disciplined multiple times for harassment, failure to complete assigned duties, failure to meet the needs of patients and medication errors. Yet she continued to work in the field.

The inquiry suggests a need for cultural change. This finding is consistent with our research.

Patients we interviewed often spoke of feeling dehumanized in current health care culture. They also emphasized the need to recognize the humanity of clinicians to allow for more open interactions and transparency.

If we want to find some meaning in these tragic events, we must remember that we are not different from the patients victimized in this case. Patients are not a small special interest group and we would benefit from remembering that everyone is, in some ways, a patient in waiting.

Fiona MacDonald is Associate Professor, Department of Political Science, University of the Fraser Valley.

Karine Levasseur is Associate Professor, Department of Political Studies, University of Manitoba. They are expert advisors with EvidenceNetwork.ca, based at the University of Winnipeg.