Doctors : on overload

If you land in hospital, demand a consultant, or failing that, a pass out the door.

A survey of 114 American house officers practicing internal medicine concluded that one third had made serious diagnostic errors, almost the same number had made mistakes in prescribing, one fifth had made mistaken evaluations, and 11 per cent procedural complications. In 90 per cent of these cases, patients had suffered serious adverse outcomes, and nearly one third had died.

These figures were for American doctors who work fewer hours than do British junior doctors.

Nevertheless, according to the house officers, who filled out questionnaires, only half had discussed the mistake with their superiors and only a quarter had told the patients themselves or their families.

"Residents were less likely to make constructive changes if they attributed the mistake to job overload," said the authors at the University of California at San Francisco. "They were more likely to report defensive changes if they felt the institution was judgmental. Decreasing the work load and closer supervision may help prevent mistakes. To promote learning, faculty should encourage house officers to accept responsibility and to discuss their mistakes."