This document discusses medical errors, including definitions, types, causes, disclosure, and prevention. It defines medical errors as the failure to complete a planned action as intended or using the wrong plan. Types of errors include missed diagnoses, inappropriate discharges, and incorrect dosages. Common causes are ignorance, fatigue, faulty communication, and system flaws. When disclosing errors to patients, physicians should do so promptly, accept responsibility, apologize, and outline plans to rectify harm and prevent recurrence. Error prevention includes checklists, electronic records, guidelines, and staff training. In Saudi Arabia, medical errors are divided into regulatory offenses and technical offenses, which are evaluated based on standards known by practitioners and acknowledged by experts. The Medical Legal Committee investig

1. Asst. Prof., Dept. of Medical Ethics
Alfarabi Colleges
Dr. Ghaiath M. A. Hussein
Professionalism and Ethics Education for Residents (PEER)
Medical Errors
(MEs)

2. Outline
 Definitions of terminology related to Medical Error (ME)
 Types & Examples of medical errors
 Causes of ME
 Disclosure of ME
 Prevention of Medical Error

3. Definitions of Medical Error
 The failure of a planned action to be completed as intended,
or as the use of a wrong plan to achieve an aim.
A preventable adverse effect of care, whether or not it is
evident or harmful to the patient.
 This might include an inaccurate or incomplete diagnosis or
treatment of a disease, injury, syndrome, behavior, infection,
or other ailment.
 An act or omission that would have been judged wrong by
knowledgeable peers at the time it occurred

4. Types and Examples of Medical Errors
EXAMPLEERROR
Missed diagnosisDiagnosis or evaluation
Inappropriate or premature dischargeMedical decision-making
Waiting when treatment is indicatedTreatment
Incorrect dosageMedication
Failure to review treatment planInadequate supervision
Failure to convey informationFaulty communication
Faulty techniqueProcedural complications
Inappropriate or premature dischargeMedical decision-making
*Wu AW, McPhee SJ, and Christensen JF. Mistakes in Medical Practice, Chapter 32 in Behavioral Medicine in Primary
Care. 1997 Appleton and Lange, Stamford, CT. Edited by MD Feldman and JF Christensen.
*Adapted, with permission, from Wu AW at al: Do house officers learn from their mistakes? JAMA 1991;
265:2089. American Medical Association

5. Common Causes of Medical Mistakes
 Ignorance
 Inexperience
 Faulty judgment
 Hesitation
 Fatigue
 Job overload
Faulty communication
 Failure to monitor closely
 System flaws
*Wu AW, McPhee SJ, and Christensen JF. Mistakes in MedicalPractice,Chapter 32 in Behavioral Medicine in Primary Care. 1997
Appleton and Lange, Stamford, CT. Edited by MD Feldman and
JF Christensen.

6. Disclosing Error to Patients (refer to
BBN Lecture)
Notify your professional insurer and seek assistance
from those who might help you with disclosure (e.g.,
unit director, risk manager)
Disclose promptly what you know about the event.
Concentrate on what happened and the possible
consequences.
Take the lead in disclosure; don’t wait for the patient
to ask.

7. Disclosing Error to Patients Cont.
 Outline a plan of care to rectify the harm and prevent
recurrence.
 Offer to get prompt second opinions where appropriate.
 Offer the option of a family meeting and the option of
having lawyers present.
 Document important discussions.
 Offer the option of follow-up meetings.
 Be prepared for strong emotions.
 Accept responsibility for outcomes, but avoid attributions of
blame.
 Apologies and expressions of sorrow are appropriate.

8. Prevention of Medical Errors
Examples in medical practiceError prevention measures include
Checklists, flow sheets, tickler
systems
Reduced reliance on memory
Handheld computer, electronic
medical records
Improved information access
Fail-safe to avoid prescribing two
drugs that interact fatally
Error-proofing systems.
Office formularies, guidelines
synthesis
Standardization
Staff in services.Training on error identification and
prevention

9. LEGAL ASPECTS OF MEs IN KSA

10. Legal aspects of MEs in KSA
Offences in practice are divided into:
• Regulatory offences:
– Those are not related to practice, e.g. practicing without
official permission, or provided inaccurate information to
get such permission, or claimed a specialty beyond his/her
scope
• Technical Offences (MEs):
– These are the offences in which the practitioner deviates
from the known theoretical and practical standards, which
must be known by a practitioner of his/her level, whether
such knowledge is old or recent.
– This condition of knowledge is established by two
conditions:
• To be based on scientific means of knowledge (e.g. research)
• To be acknowledged by an official body of experts (e.g. MOH,
professional bodies)

11. General rules
• A medical error should be obvious and
beyond doubt, i.e. not open for
possibilities and thus cannot be
interpreted differently
• If the practitioner does/did what an
average doctor of his/her level in the
same discipline; this action can not be
described as medical error.

12. The Medical Legal Committee
‫الشرعية‬ ‫الطبية‬ ‫اللجنة‬
• The composition of the Medical Legal
Committee:
1. A Grade A Judge assigned by the Minister of
justice
2. A governmental Counsellor
3. Two qualified and specialized physicians,
assigned by the Minister of Health
4. One staff member from a medical college
assigned by the Minister of Education.

13. How to prove the medical error?
The judge relies on either:
1. Confession of the practitioner that s/he
committed the ME under investigation
2. Witness of a colleague who attended
the incident, or those of specialty in the
relevant discipline
3. Documents, namely the medical records
and the written notes, given they were
not prone to manipulation by the
accused practitioner.

14. Questions for Discussion
 How do I decide whether to tell a patient about an error?
 Do physicians have an ethical duty to disclose information about
medical mistakes they, or their colleagues, did to their patients?
 Won't disclosing mistakes to patients undermine their trust in
physicians and the medical system?
 By disclosing a mistake to my patient, do I risk having a malpractice suit
filed against me?
 What if I see someone else make a mistake?
http://depts.washington.edu/bioethx/topics/mistks.html

15. THANKS FOR YOUR
ATTENTION