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December 1994: Medical error meets journalism Date: 01/06/20

Michael L.

By Michael L. Millenson

In December, 1994, medical error met journalism.

That month, Dr. George Lundberg, the editor of JAMA, decided to print two articles on medical error by Harvard researchers. "Error in Medicine,” by Dr. Lucian Leape, laid out the evidence showing how commonplace and damaging medical errors were. A companion piece by Dr. David Blumenthal, “Making Medical Errors Into ‘Medical Treasures,’” urged physicians to give up their “ostrichlike” attitude about error frequency and impact.

In a book published some years later, Lundberg said he’d deliberately placed the articles in the Dec. 21 issue hoping no reporter would notice. At the beginning of 1994, I’d left the Chicago Tribune to write a book about the quality of American medicine with a grant from the Robert Wood Johnson Foundation. I quickly discovered that more than decade on the beat had left me ignorant about the horrifying pervasiveness of treatment-caused harm.

Fortunately, news people don’t all take off for their winter homes at the end of December. The frank talk about medical error in a prestigious journal was first picked up by a Boston public radio reporter and later by The Washington Post. The resulting commotion, wrote Lundberg, brought blistering letters accusing him of being a traitor.

Earlier in December, a popular Boston Globe health columnist named Betsy Lehman seemingly succumbed to breast cancer, leaving behind a husband and two young children. But a few months later, in March 1995, a series of articles that began with an expose by Globe reporter Richard Knox revealed that Lehman had actually died from a mistaken chemotherapy overdose at the Dana-Farber Cancer Institute, a renowned Harvard-affiliated hospital.

Suddenly, medical error had become intensely personal in the capital of American medicine and, given those involved, major national news. A flurry of other medical error stories followed in other publications around the country.

Those stories with real people and real situations helped give the numbers in the "To Err is Human" report, essentially a blended estimate from published studies, their extraordinary impact.

The Institute of Medicine (IOM) – now the National Academies of Medicine – generally does research funded by others. But in a December 2015 symposium, the individuals behind "To Err" acknowledged that no one would pay for a report on medical error.

“We were told, ‘You’re going to undermine the confidence of patients in their doctors and hospitals,’” recalled Dr. Kenneth Shine, former IOM president. It took three years of saving money from the IOM endowment to accumulate enough money to then attain matching funds from the National Academy of Sciences, he added.

Given the topic’s professional unpopularity, those behind the report wanted to ensure it would be accessible to the general public. Their biggest fear was they’d have no impact if it was the kind of typical report that “put everyone to sleep,” in the words of Janet Corrigan, who oversaw the IOM’s quality and safety program.

So the IOM hired a public relations firm and organized a one-day workshop of print and electronic media journalists to seek advice on how to make the report compelling. They were told not to talk about “quality” of care – this was at a time when Ford’s slogan was “Quality is Job One” – but to emphasize the term “medical error.” (Doctors had long preferred the euphemistic term, “iatrogenic disease.”) Also, there had to be villains and victims. And there had to be proposed solutions that were actionable.

When "To Err" came out, recalled Leape, he was skeptical that a report based on old studies would have an impact. But “the combination of outrageous numbers” – 44,000 to 98,000 dead each year, and more than 1 million injured – “and the message, ‘It’s not bad people, it’s bad systems’ turned out to be very powerful,” Leape said. “It turned the conversation around.”

In hindsight, said several symposium participants, they’d underestimated how difficult it would be for the health care system to change.

Said Dr. Donald Berwick, one of the report’s lead authors, “We didn’t understand the massive power of habits.”

Michael L. Millenson is the author of the book, "Demanding Medical Excellence: Doctors and Accountability in the Information Age," the president of Health Quality Advisors LLC and an adjunct associate professor of medicine at Northwestern University’s Feinberg School of Medicine. Earlier in his career, he was a health-care reporter for the Chicago Tribune.