Book Review

Errors, Medicine and the Law presents the knowledge and experience of its authors in an exploration of how mishaps occur and how people are held accountable for them. It looks at the moral components of the debate surrounding the most effective way to manage the impact of error on individuals, and deduces that most practitioners involved in such incidents were not culpable for the results. Their conclusion stems from a review of the complex environment of medicine.

With the benefit of their complementary experiences, Merry and McCall Smith successfully analyze challenging medicolegal issues. Alan Merry is a practicing anesthesiologist who was active in New Zealand working toward the reform of criminal medical liability laws as they relate to negligently caused harm. Alexander McCall Smith is an educator in medical law in Edinburgh and has been involved in that arena for over 20 years. Although neither is from the US, the authors draw on lessons learned from the American medical landscape and use them, along with examples from their countries and other jurisdictions, to aptly illustrate legal and ethical issues.

The authors broaden their approach to human error with examples taken from outside medicine, such as mistakes that occur in driving a car or playing golf. In doing so they adopt the approach of Donald Norman in the oft-referenced The Psychology of Everyday Things, a study of how design and organization of daily activities can allow for error to happen.¹ This approach works well by allowing the authors to develop from easily understood scenarios a view of the complex nature of error in medicine. Through this means, Merry and McCall Smith draw a picture of how error occurs that would help those convinced it could “never happen to me” visualize how even the most effective and educated among us can err.

Much of this book focuses on the role that blame plays in our response to error, how it is talked about in both social and legal circles, and where blame is placed in light of an accident. Merry and McCall Smith’s coverage of this part of the topic distinguishes this publication from other medical titles that serve as an introduction to human error, such as Bogner’s classic Human Error in Medicine.² A discussion of culpability frames a description of negligence, recklessness, and blame. A classification of levels of blame is presented. The standard of law—especially as it is affected by unrealistic expectations of not only what is medically possible, but what is often substituted as “ideal care” through the opinions of experts—could be positively influenced by this book’s portrayal of how errors and accidents occur. This discourse concludes with a discussion of the tort system, its negative affects on safety efforts, and some suggested alternatives.

Error, Medicine and the Law is nicely referenced: many of the “usual suspects” (e.g., Leape, Runciman, Reason, and the IOM) are represented in notes throughout the text. Classic studies, government reports, case law, and news stories alike are brought to bear in support of the concepts presented here, illustrating that error reaches into many avenues with results that can be difficult to explain. An alphabetized list of resources would have made a nice appendix to this volume, thereby offering easy access to references for further study.

Merry and McCall Smith have done a commendable job in their take on accountability in medical error. Readers who are just beginning to form their opinions on the issue would do well to read their work.

Lori A. Zipperer
Lori A. Zipperer, a Cybrarian, is an information projects consultant focusing on patient safety issues.

References

1. Norman DK. The Psychology of Everyday Things. New York: Basic Books, 1988.
2. Bogner MS, ed. Human Error in Medicine. Hillsdale, NJ: Lawrence Erlbaum, 1994.