Medical errors and uncertainty in primary healthcare: A comparative study of coping strategies among young and experienced GPs

Abstract

Objective. To study coping differences between young and experienced GPs in primary care who experience medical errors and uncertainty. Design. Questionnaire-based survey (self-assessment) conducted in 2011. Setting. Finnish primary practice offices in Southern Finland. Subjects. Finnish GPs engaged in primary health care from two different respondent groups: young (working experience ≤ 5years, n = 85) and experienced (working experience > 5 years, n = 80). Main outcome measures. Outcome measures included experiences and attitudes expressed by the included participants towards medical errors and tolerance of uncertainty, their coping strategies, and factors that may influence (positively or negatively) sources of errors. Results. In total, 165/244 GPs responded (response rate: 68%). Young GPs expressed significantly more often fear of committing a medical error (70.2% vs. 48.1%, p = 0.004) and admitted more often than experienced GPs that they had committed a medical error during the past year (83.5% vs. 68.8%, p = 0.026). Young GPs were less prone to apologize to a patient for an error (44.7% vs. 65.0%, p = 0.009) and found, more often than their more experienced colleagues, on-site consultations and electronic databases useful for avoiding mistakes. Conclusion. Experienced GPs seem to better tolerate uncertainty and also seem to fear medical errors less than their young colleagues. Young and more experienced GPs use different coping strategies for dealing with medical errors. Implications. When GPs become more experienced, they seem to get better at coping with medical errors. Means to support these skills should be studied in future research.

Prescribing errors and uncertainty: Coping strategies of physicians and pharmacists in a tertiary university hospital

“…[9,10,18,36] In line with other studies, fear and decision uncertainty seem to reduce with the accumulation of experience. [18,37] Our study shows low percentages of doctors and pharmacists respectively featuring in the respective dimensions of: avenue to discuss prescribing errors when pointed out, notification or communication of errors among the professional groups, and increased uncertainty for the occurrence of errors. Other studies show that physicians are more willing to discuss with their colleagues but less willing to discuss with their patients.…”

“…Other studies have shown that proactive approach to error reduction is achieved through education, information, effective communication and enhanced proficiency in prescribing. [18,34,35] About 20% of doctors and 60% of pharmacists in our study view medication error reporting as an avenue for improvement, not for punishment. Our findings fall below expectation when compared to other studies where the liability weighs on self reporting decisions.…”

“…The outcome may be as a result of non-stringent enforcement of the law and culture-bound tolerance to medical errors (to err is human) in our environment, unlike higher results for physicians in other cultural settings. [18] The adult literacy rate in the Nigeria population is about 56.9%, [29] and might have contributed to people not demanding for their right to quality health care if violated. Only 4.3% of the doctors have used clinical support systems to reduce prescription errors, while about 5.7% of the pharmacists have used computerized physician order entry or any electronic support system before.…”

“…[17] Coping differences between young and experienced GPs in primary care were assessed. [18] Over-confidence is a risk factor for diagnostic error in medicine. [19] Junior doctors were aware of their prescribing errors, yet were confident in their prescribing skills and apparently complacent about the potential consequences.…”

Challenges of implementing sustainable health care delivery in Nigeria under environmental uncertainty

“…Result showed that care-seekers had more preference for local providers than for outsiders irrespective of the latter's legitimacy. A comparative study of coping strategies to medication errors and uncertainty among young and experienced general practitioners (GPs) in a primary health care was carried out by Nevalainen et al [27] Kai et al [28] carried out a qualitative study of professional uncertainty and disempowerment in responding to ethnic diversity in health care. Results suggest the potential mechanisms by which health professionals may inadvertently contribute to ethnic diversity.…”