Halting Steps

Early studies of medical harm appeared in the 1950s, with rates of injury little different from those reported 50 years later. Philosopher Ivan Illich criticized medicalization of everyday life, using annual deaths from auto accidents as an example. Malpractice concerns became entangled with safety, and the first malpractice crisis in the US came about due to advances, rather than deficiencies, in care. The Harvard Medical Practice Study (HMPS) renewed interest in medical harm as a cause of malpractice suits in a series of four papers in the prestigious New England Journal of Medicine. Although it was not a pre-defined outcome of the study, one paper by Lucian Leape reframed the problem as one of medical “error”; the other three did not use the term. Lucian Leape fortuitously drew on error research in cognitive psychology and other safety science work on “error” stemming from the research triggered by the Three Mile Island nuclear disaster and other accidents. He formulated those concepts in a form digestible by health professionals and published them in the widely read medical journal JAMA—Journal of the American Medical Association. The figure of 100,000 annual deaths was first circulated.