Doctors are told to change the way they think to avoid deadly errors

DOCTORS must improve decision-making to reduce mistakes in patient care that could lead to serious injury or death, a leading expert will warn today.

Some estimates suggest that around one in ten patient contacts in hospitals result in an error being made, although the majority are thought to be minor.

A conference in Edinburgh today will hear calls for a step change in the approach to patient safety, with warnings that doctors must learn to think more critically to cut mistakes in Scottish hospitals.

Professor Pat Croskerry, from Nova Scotia, Canada, an expert in patient safety and clinical decision-making, is also calling for medical schools to adapt training to make sure new doctors are better placed to make decisions that affect patients.

Today's conference has been organised by the Royal College of Physicians of Edinburgh, the Scottish Intensive Care Society and NHS Quality Improvement Scotland.

The exact number of "adverse incidents" in Scottish hospitals remains unclear, but there have been a number of high-profile cases, including multi-million-pound compensation pay-outs for mistakes during birth leading to life-long disability.

Another well-known incident, resulted in teenage cancer patient Lisa Norris receiving a massive overdose of radiation during her treatment.

While most adverse incidents are less serious and patient safety is improving, Prof Croskerry will say that doctors are still not thinking carefully enough in their clinical decision-making.

In some cases, he will say, this could have serious consequences for patients including the risk of permanent disability or death.

"Doctors are required to make clinical decisions on a daily basis which can literally have life or death implications for patients, not only in emergency situations but also in the daily routine of general practice," Prof Croskerry will say.

"The development of evidence-based medicine has greatly helped to ensure that patients receive the most appropriate treatment based upon the available scientific evidence, but in so doing we have put less emphasis on the human element and this has been undervalued.

"By focusing solely on the available evidence, doctors can easily miss warning signs or indicators of more serious disease which can be learned through experience."

An example of "critical thinking" could be where a doctor is presented with the case of a patient with a seemingly minor condition, such as constipation or back ache, but through examining other possible causes of these problems they see signs of a more serious disease.Dr Graham Nimmo, from the RCPE and a consultant in intensive care medicine, said: "As doctors, we are keen to ensure the quality and reliability of the healthcare provided and are continually developing safer systems in which we believe patients in Scotland can have confidence."