To the Editor.
—The article by Dr Leape1 is provocative and offers a humane approach to a problem that creates suffering for patients and for physicians. However, Leape does us a disservice by not clearly distinguishing between true errors and other adverse outcomes. He defines error as "an unintended act (either of omission or commission) or one that does not achieve its intended outcome." This definition is too broad to be useful and obscures the difference between error and adverse outcome. For example, he implies that because 35% to 40% of autopsies reveal diagnoses not found in vivo, these are manifestations of error. The truth is that patients present with illnesses of varying degrees of complexity—some obvious, some covert. Diagnoses missed until autopsy may simply reflect the uncertainty inherent in medicine itself.Similarly, he suggests that iatrogenic illness is a consequence of error, yet it is one of the
Cunnington JPW. Error in Medicine. JAMA. 1995;274(6):458. doi:10.1001/jama.1995.03530060031018