Medical malpractice, mistake prevention, and compensation.

Clinicians' fear of malpractice litigation is the most significant obstacle to the open reporting of medical mistakes. Without open reporting of medical mistakes, however, root cause analysis of mistakes cannot be done, thus undermining efforts to implement safeguards to minimize the occurrence of future mistakes. Efforts to prevent medical mistakes, therefore, must first directly address clinicians' fear of malpractice litigation. In this paper, we explore the relationship between the current malpractice system and clinicians' fear of litigation. Ultimately, we argue that both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.     

Normative and Substantive Expertise in Multiple Hypotheses Evaluation

We distinguish two criteria for evaluating the judgments of trained professionals. One criterion is conformance with a theoretical model and the other is conformance with known external criteria. Further, we label judgments that depart from a theoretical model as errors and those that depart from known external criteria as mistakes. Following this distinction, we hypothesize that auditors′ multiple hypotheses judgments will be characterized by errors but not mistakes. This hypothesis was tested by asking professional auditors to evaluate multiple hypotheses. The results confirm our expectations. Auditors′ judgments reflected ecological base rate information, and they appropriately ignored nondiagnostic evidence. Moreover, auditors did not exhibit a perseverance bias and 84% of them identified the correct hypothesis. The absence of mistakes reflect substantive expertise. Conversely, auditors′ probabilities were not additive, and, when a hypothesis was eliminated, they did not adjust beliefs for the remaining hypotheses. These errors reflect a lack of normative expertise. A second study employed inexperienced subjects to establish whether the strong substantive performance of the professional auditors was attributed to their expertise or was an artifact of the task. The results from the second study were strongly supportive of the substantive expertise explanation. Taken together, these results suggest that substantive expertise can help contain mistakes but it is not sufficient to mitigate errors. Further, lack of normative expertise can lead to errors but these errors do not translate into mistakes. The paper concludes that the distinction between normative and substantive expertise on one hand and errors and mistakes on the other is crucial to understanding when basic findings will generalize to professional settings.     

What is meant by telling the truth: Bonhoeffer on the ethics of disclosure

This article explores Dietrich Bonhoeffer's writings on truth telling with reference to the problem of medical error in the US, the UK, and other developed nations, with particular attention to physicians' resistance to disclosing their own mistakes to injured patients and their families. The brief essay 'What is Meant by "Telling the Truth"?' and its historical context--Bonhoeffer's imprisonment and interrogation in 1943--is proposed as a text for medical ethicists and others seeking to overcome the barrier of the 'hidden curriculum' within the culture of medicine, which encourages medical students and physicians to conceal their errors and to fear disclosure.     

在什么情况下员工会汇报差错?基于秘密分享视角

差错在工作场所中并不鲜见, 然而有关差错诊断的研究相对匮乏。基于此, 以员工主动差错汇报为切入点, 分析影响员工差错汇报的因素。结合秘密分享框架, 提出差错特点(差错严重性与可见性)对员工的焦虑感、反刍和汇报责任感产生正向影响; 而焦虑感、反刍和汇报责任感会促使员工采取差错汇报行为, 由此上述个体感知中介差错特点与差错汇报之间的关系; 此外, 个体责任心、领导容错性以及团队心理安全会作为边界条件进一步影响上述员工犯错后的感知, 并最终影响其差错汇报行为。     

Real Men Don’t Make Mistakes: Investigating the Effects of Leader Gender, Error Type, and the Occupational Context on Leader Error Perceptions

Purpose

Despite the fact that leaders make mistakes, little attention has been paid to the effects of errors on subordinate perceptions. This study investigated the influence of errors on perceptions of leader competence, effectiveness, and desire to work for the leader. It also examined the effects of gendered expectations on perceptions of male and female leader errors by investigating the interactions that occur between the leader’s gender, the type of error, and the occupational context.

Design/Methodology

A sample of 284 undergraduates read a series of fictional employee emails describing a leader’s behavior and responded to several measures while envisioning themselves as subordinates of the leader.

Findings

Results suggested task and relationship errors exert damaging and differential effects on perceptions of leader task and relationship competence, respectively, and equally damage desire to work for the leader. Male leaders were perceived as less task and relationship competent, desirable to work for, and effective than female leaders for committing errors in a masculinized domain.

Implications

This study suggests leader errors matter, and that current leadership models ought to be expanded to account more clearly for them. Moreover, it offers insight into the role of gendered expectations in determining perceptions of male and female leader errors.

Originality/Value

This study is one of the first to empirically examine leader error perceptions and the effects of gender stereotypes on these perceptions. It represents a step toward understanding evaluations of male and female leaders, not when they succeed, but when they make mistakes.     

Processing a display even after you make a response to it. How perceptual errors can be corrected

We know that when people make responses which they did not intend they can discover this by monitoring kinaesthetic and visual feedback. It is less clear whether they can also correct perceptual errors which occur when they mistake one signal for another. It was argued that, if they can sometimes do this, extra errors which occur when discriminations become more difficult may be detected and corrected. Experiment I compared the ability of young fit subjects to detect errors made during easy and during difficult discriminations between tone signals. There was no evidence that any additional errors made to difficult discriminations were detected. Fast errors were detected, slower errors were not. The results were consistent with the idea that subjects can detect fast motor errors by monitoring feedback, but that they cannot detect perceptual mistakes.

In Experiment II subjects made easy and difficult line length discriminations. Displays lasted for 100 ms, 200 ms or 500 ms and were followed by random masks. In this case, fast errors were again corrected more frequently than slow errors but eight aspects of the data suggest that subjects could, and did, correct perceptual as well as motor mistakes and that they managed to do this by continuing to process a display after the moment at which they may have initiated an impulsive response to it. The data are interpreted in terms of a “Committee Decision” model for extended perceptual processing previously applied to other, similar data by Rabbitt and Rodgers (1977) and Rabbitt, Cumming and Vyas (1978).     

SHOULD SIGNIFICANCE TESTS BE BANNED?

Abstract— Significance testing of null hypotheses is the standard epistemologicat method for advancing scientific knowledge in psychology, even though a has drawbacks and it leads to common inferential mistakes These mistakes include accepting the null hypothesis when it fails to be rejected, automatically interpreting rejected null hypotheses as theoretically meaningful, and failing to consider the likelihood of Type II errors Although these mistakes have been discussed repeatedly for decades, there is no evidence that the academic discussion has had an impact A group of methodologists is proposing a new approach simply ban significance tests in psychology journals The impact of a similar ban in public-health and epidemiology journals is reported     

Influence of Maternal Depressive Symptoms on Ratings of Childhood Behavior

This study uses information collected on two occasions from a probability sample of families with 5- to 12-year-old children (N = 1151) participating in a general population study in 1983 and follow-up in 1987. It evaluated the importance of maternal bias in the assessment of child behavior by comparing the relative strengths of association between maternal depression and childhood behavior and between maternal depression and mother reporting errors. Conduct problems and hyperactivity were measured as latent criterion variables constructed from mother, teacher, and youth (aged 12 to 16 years) ratings and their associations with maternal depression were modeled using covariance structure analysis. The analyses revealed that maternal depression was associated significantly with conduct problems ( = .35) and hyperactivity ( = .38) among 5- to 7-years-olds in 1983 but not 4 years later in 1987. None of the associations between maternal depression and mother reporting errors were significant. Among 8- to 12-year-olds in 1983, maternal depression was associated significantly not only with conduct problems ( = .17) and hyperactivity ( = .15) but also with mother rating errors of these behaviors ( = .13 and .17, respectively). Four years later in 1987 when this cohort was 12 to 16 years old, the only significant association was between maternal depression and conduct disorder ( = .25). Although evidence exists for associations between maternal depressed mood and mother rating errors, there also appears to be a substantive association between maternal depression and childhood behavior.     

Errors in Planning and Decision-making and the Nature of Human Information Processing

Cet article aborde la question de la régulation de l'action humaine dans le contrôle des systémes hautement complexes. La "régulation de l'action" recouvre l'intéraction de la fixation des objectifs, des activités de prévision, de l'élaboration des hypothèses, du planning, de la prise de décision et de la réflexion. Des erreurs et des fautes caractéristiques relevant du planning et de la prise de décision sont décrites et rapportées à divers aspects du système humain de traitement de l'information. Beaucoup de fautes et d'erreurs renvoient à un nombre restreint de caractéristiques de l'esprit humain. On montre en outre qu'il n'est en rien facile d'échapper à ces fautes puisque ces processus de traitement de l'information que détient l'esprit humain sont parfaitement fonctionnels dans d'autres contextes.
This article deals with human action regulation when controlling very complex systems. "Action regulation" means the interaction of goal elaboration, forecasting activities, hypothesis formation, planning, decision making, and self reflection. Typical errors and mistakes in human planning and decision making are reported and related to characteristics of the human information processing system. It is demonstrated that a lot of very different errors and mistakes are based on a few characteristies of the human mind. Additionally we demonstrate that it is in no way simple to avoid these mistakes, as these information processing characteristies of the human mind are otherwise quite functional in a number of contexts.     

Schizophrenia and Familial Communication: A Brief Note on Follow-up Studies and Replications

In 1975 Helge Sølvberg and I published an exploratory paper in Family Process reporting on situation-specific differences in communication efficiency in parental couples having and not having schizophrenic offspring. In the years since, a series of studies reproducing and extensively corroborating the findings from this study have been conducted in Oslo. The following is a brief note to inform the readers of Family Process about this subsequent work. A particular reason for doing so is the huge problem of the language barrier in scientific transnational communication. (Most of the papers, dissertations, and books prepared in connection with our projects appear in Norwegian, which is of course a "minority" language as regards the international scientific community in our field.) In the present note I have taken great care to give references to relevant Norwegian studies that are now available in English.     

One Hundred Years of Reading Research: Successes and Missteps of Edmund Burke Huey and Other Pioneers

For more than 100 years, research on the psychology of reading has proliferated. In this article, the authors wish to help modern reading researchers understand the origins of the discipline and benefit from its history. This article draws heavily on Edmund Burke Huey's 1908 landmark volume The Psychology and Pedagogy of Reading, the first scientific treatise in the field of literacy. Starting with Huey, some of the early pioneers’ enduring contributions to the field are highlighted but especially their scientific mistakes that ultimately led the field in promising new directions. An overview of the modern controversy between phonics and whole language instruction is underscored regarding how it arose from early errors.     

An error analysis of misspellings made by learners of English as a first and as a second language

About 700 misspelled words were collected from the responses produced on a fill-in-the-blank task by two groups of advanced learners of English, (1) English-speaking children (9–11 years) and (2) Spanish-speaking adults studying English. The spelling errors were coded using a detailed categorization system (whose use and rationale are described), and the resulting tabulations were analyzed for differences between the two subject groups or differences across error types. The two groups were similar in that they both made proportionally more vowel than consonant errors. On the other hand, significant differences between the subject groups were found in three of the major categories: The Spanish speakers made more errors involving consonant doubling, while the native English speakers made more involving the unstressed vowel schwa (||) and the grapheme silent |e|. It is argued that these differences stem from the language backgrounds and resulting spelling strategies of the two groups, and the paper concludes with a discussion of the need for other studies comparing the spelling errors of first-and second-language learners.     

The significance of prognosis for a theory of medical practice

A typical problem of modern medicine results from the gap between scientific knowledge and its application in individual cases. Whereas scientific knowledge is generalized and impersonal information, medical practice takes place under conditions which are singular, individual and irreversible. The paper examines whether prognosis is able to bridge this gap or hiatus theoreticus. It is shown that diagnosis of a single case always relies on prognostic considerations. The individual prognosis (as distinguished from the nosologic prognosis of a certain disease) enables doctors to apply scientific knowledge and practice according to the actual situation, the history and personal preferences of the patient. Prognosis – not diagnosis – therefore legitimizes medical interference. A methodology of individual prognosis as the basis for a theory of practice is discussed.     

Social genomics: genomic inventions in society. The nature of what's to come

This paper identifies several kinds of intellectual mistakes that proponents of genetic engineering make, in defending their views and characterizing the views of their opponents. Results from research in the social sciences and humanities illuminate the nature of these mistakes. The mistakes themselves play a role in allowing proponents to gather support from other protagonists in the social controversies involving science and technology. Understanding the controversies requires understanding that innovations are components of complex and ill-structured social problems; the "right answer" does not follow from scientific or technological breakthroughs. If the problems are identified correctly, issues of non-economic or non-market values and political and individual rights will need to be addressed.     

The Financial Dimension of Integrated Behavioral/Primary Care

There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.     

应当建立科学的医疗纠纷技术鉴定体制

现行的医疗纠纷技术鉴定模式年来在解决医疗纠纷中起到了重要作用,但随着卫生改革的进一步深化和法制的日趋健全,以及人们法律意识的不断提高它的缺陷也日益突出。应当建立新的医疗技术鉴定管理体制,鉴定委员会的人员鸺成,增强医疗技术透明度,建立时效制度和回避制度。     

论药物治疗安全：药疗错误的科学定位与安保革新

面对越来越多的最普遍的一种医疗错误—药物治疗错误,以及由此带给患者的身体损害和经济损失,必须对药疗错误进行科学定位和对患者安全保障体系与措施的革新。本文不在于详尽地论述药疗错误和安保的革新,而是通过对药疗错误的科学定位,提出对药疗错误的预防优先和以医者与患者为中心的药疗安全保障,强调重在研究和应用与药疗安全问题相关的健康信息技术和改变认知与处理药。总的认为:关于药疗安全与药疗错误,执行安全措施的障碍和改善药疗管理的当前和可能的机制以及我们应当知道什么和可以怎样做为好。     

Hypercorrection of high confidence errors: Prior testing both enhances delayed performance and blocks the return of the errors

How people correct their mistakes and sustain those corrections over time is a problem of central interest to education. It might be thought that the erroneous beliefs that people hold with high confidence would be especially difficult to correct. Interestingly, people correct these high confidence errors more easily than low confidence errors, a phenomenon known as the ‘hypercorrection effect’. Unfortunately, though, with a delay in testing there is a tendency for some of these high confidence errors to reemerge – a finding with serious consequences for education. This study investigated the effect of intervening a test immediately after corrective feedback on preventing the return of the errors. It also investigated processing differences between prevention-focused and promotion-focused people. The most educationally important new finding was that testing immediately after corrective feedback not only greatly enhanced memory for the correct answers but also blocked the return of the errors.