Press: How the US news media made patient safety a priority
Authors: M. L Millenson
Journal: BMJ (2002)

Until journalists “remembered” patient safety, it was an issue that society and the profession had largely forgotten. Studies began to appear regularly in the medical literature after the second world war. Two of the most comprehensive, those of Don Harper Mills (Western Journal of Medicine 1978;128:360-5), which was based on records of California hospitals from 1974, and the Harvard Medical Practice Study (New England Journal of Medicine 1991;324:370-6), which was based on records of New York State hospitals from 1984, reached similar conclusions about the enormous clinical magnitude of the problem. Neither study, however, led to any substantial change in actual practice.

Then, in early 1995, a seeming epidemic of errors, including wrong-site surgery and medication errors, erupted among US hospitals. High profile mistakes garnered intense coverage ranging from tabloid TV shows to the Wall Street Journal. The most prominent incident was the revelation by the Boston Globe that its 39 year old health columnist, Betsy Lehman, had been killed by a massive chemotherapy overdose while being treated for breast cancer at the renowned Dana-Farber Cancer Institute. Lehman was the mother of two young daughters.

An alarmed American Medical Association launched a public relations counter-offensive that contrasted “isolated” mistakes with an “extraordinarily high percentage” of “positive” and even “miraculous” doctor-patient encounters. Internally, however, the AMA realised its stance was untenable. In October 1996 the AMA unveiled a National Patient Safety Foundation. Talk of “isolated” errors was replaced by an acknowledgment that mistakes were “common” and that systematic change, rather than blaming individuals, was needed.

It was the news media's history of scepticism about the medical profession that ultimately made the altered AMA attitude possible. By the mid-1960s, respectful coverage of medical “miracles” was giving way to more tough minded inquiries. In 1966 journalist Martin Gross's The Doctors estimated that two million unnecessary operations were performed annually. Five years later, surgeon “Lawrence Williams”—writing under a pseudonym to protect himself from colleagues—produced an insider tell-all, Unnecessary Surgery.

Publicity led to Congressional hearings that focused on the avoidable deaths of children from unnecessary tonsillectomies. Although the medical literature since the 1950s had condemned the overuse of tonsillectomies, the profession acted to limit them only after being publicly shamed.

Similarly, while anaesthesia guidelines are often cited today as an example of self policing, it was actually a television expose of anaesthesia accidents in the 1980s that led the American Society of Anesthesiologists to form a patient safety committee (see www.physiciansnews.com/spotlight/200wp.html). Also in the 1980s, the death in a New York hospital of Libby Zion, daughter of a New York Times reporter, led first to public scandal and then to state legislation limiting work hours of often sleep-deprived medical residents.


The most prominent example of media impact was the 1999 Institute of Medicine report To Err is Human: Building a Safer Health System. This concluded that 48,000 to 98,000 Americans died in hospitals every year because of preventable medical errors. It included references to named patients whose stories had appeared in the media, as well as catchy comparisons to the magnitude of deaths from drunk driving and breast cancer. 


The international picture
The news media has been an important force in prompting patient safety improvement efforts around the world. In 1995, for example, The Quality in Australian Health Care Study (Medical Journal of Australia 1995;163:458-71), with its estimate that nearly 17% of hospital admissions were associated with an adverse event, drew intense media attention. One result was the development and implementation of the Australian Incident Monitoring System (AIMS) through a contract with the Australian Patient Safety Foundation. Meanwhile, local scandals and the furore caused by the To Err is Human report in the United States have prompted the news media in Europe and elsewhere to focus on medical errors. In Britain, for example, a four part television documentary, Why Doctors Make Mistakes, was broadcast in October 2000, while in Canada the news magazine Maclean's gave front cover play to its coverage of patient safety problems.




A poll taken a few weeks after the report's release found that an astonishing 51% of the public was aware of its conclusions (see www.kff.org/content/2000/1565/HNI%20Nov-Dec1999.pdf). The public reaction, in turn, sparked federal and state legislative proposals and more news stories. All of this quickly persuaded the profession's leaders that endorsing voluntary, systemic change was imperative.

Unfortunately, it had taken scandal and the concomitant fear of public shaming to finally persuade the US medical profession's leadership to adopt a systematic approach to error prevention that had been available for many years.