Doctor-patient relationships, laws, clinical guidelines, best practices, evidence-based medicine, medical errors and patient safety

Abstract

Patient safety has now become a mantra of modern medical practice. Rules, laws, guidelines, evidence and best practices are frequently invoked to improve patient safety. These are not new; they have governed the practice of medicine since antiquity. A set of laws, known as the Code of Hammurabi (circa 1740 B.C.E.) have come down to us from the Babylonians after its namesake, the founder of the Babylonian empire. 1 These 282 statues or common laws governed nearly all aspects of social, political, economic and professional life including those pertaining to physicians, surgeons, veterinarians, midwifes and wet nurses. Carefully conscribed details were devoted to specifying the relationship between patients and practitioners, including fees and penalties. Problems of "internal medicine" were dealt with physicians of the priestly class who saw to internal disorders caused by supernatural factors.

NHS Improvement's Just Culture Guide: good intentions failed by flawed design

“…BC 1750) identified poor clinical outcomes considered avoidable and recorded the punishments to be administered to physicians and surgeons when they occurred. 1 A gravestone in the Shetland Islands records an early medication error, the death in 1848 of Donald Robertson, whose apothecary ‘sold him nitre instead of Epsom salts by which he was killed in the space of 5 hours after taking a dose of it’. 2 Now, 10% of NHS inpatient episodes lead to harmful adverse events, around half of them preventable, 3 and medical error has been estimated to be the third leading cause of death in the United States.…”