To the Editor.
—A significant cause for error in medicine is omitted in Dr Leape's1 elegant and well-thought-out article. As is known well to all who participate in graduate medical education, many of the mistakes that harm or kill patients are those committed by house staff.2 This unfortunate situation is also not studied or discussed in the relevant citations in Leape's article. Consideration of this problem may further explain Leape's question, "Why is the error rate in the practice of medicine so high?" In his discussion of the "Mechanisms of Cognitive Errors," he makes a compelling case for explaining why the error problem among house officers is so high. As he suggests, it is attributable to sleep deprivation, chronic fatigue, and inadequate supervision. The culture of medical practice experienced by undergraduate and graduate (resident) medical students encourages them to hide what they do not know, and it makes
Bell BM. Error in Medicine. JAMA. 1995;274(6):457. doi:10.1001/jama.1995.03530060031016