To make no mistakes is not in the power of man; but from their errors and mistakes the wise and good learn wisdom for the future. —Plutarch
*Mr. Ketterman's Case
Mr. Ketterman has a fairly unstable cardiac status. If I push him too hard, I could risk a serious cardiac event; if I don't push him hard enough, I will be increasing his morbidity. I don't want to make either mistake. (See Appendix for Mr. Ketterman's health history)
We all hope we have chosen health care practitioners who have a good amount of expertise, who can get things right. The issue of a practitioner's clinical expertise has been reinforced as crucial to good decision making by authors throughout the development and implementation of the evidence-based medicine movement. Straus et al1 define the clinical expertise element of evidence-based medicine as "the ability to use our clinical skills and past experience to rapidly identify each patient's unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal circumstances and expectations."1, p1 Similarly, physical therapists must make important choices in practice not only in determining the correct diagnosis and intervention but in performing many hands-on interventions, predicting outcomes of care, setting goals with patients and families, and coordinating resources and personnel to maximize the functional outcomes for the patient. Expertise in all these elements of practice reassures us that our physical therapist will also make good decisions regarding our care and get things right.
However, in clinical practice we all acknowledge that sometimes things don't go right. Sometimes cognitive skills, manual skills, and past experiences are insufficient for the task at hand. In these situations, clinical practice errors of varying magnitudes can occur. Of course, poor outcomes in clinical practice can also occur in a random fashion, as biological events are probabilistic in nature. More often, errors occur when the current level of scientific knowledge used to inform choices is inadequate, or when the clinician lacks knowledge, violates the patient trust in a purposeful manner, or uses faulty logic. Whatever the cause, an examination of clinical practice errors provides a source of knowledge to help us improve our level of practice.
Providing physical therapy care in a manner that reduces errors and increases patient safety should be the goal of every clinician, but it is not an easy goal to attain. Weingart2 states that the 1999 Institute of Medicine report To Err is Human3 provided evidence that medical errors pose daily risks throughout the health care system in this country but also elucidated the difficulty in estimating the magnitude and attribution of these risks. While injury of various types may occur to patients under our care, determining that these injuries are a result of clinician error is a complicated process. Weingart2 suggests that harm can result from many complex factors, including: the ...