To the Editor.
—Dr Leape1 provides a comprehensive review of the dependence of errors in medical practice on types of knowledge. Although the basic definitions of iatrogenic injury and the frequency of the injuries that follow from them may be arguable, the observation that medicine has been slow to incorporate input from other disciplines into its own efforts to improve quality of care is not.It is interesting to consider the three categories of performance (skill-based, rule-based, and knowledge-based performance) and the generally inverse relation of reimbursement levels to the skills required to analyze and respond to unique problems.Neither Leape nor Dr Blumenthal in his accompanying Editorial2 places sufficient emphasis on the influence of the tort system on efforts to improve outcomes. As I have argued previously,3 the wasteful loss of information that could be derived from systematic study of adverse outcomes is the most pernicious
Grove DD. Error in Medicine. JAMA. 1995;274(6):458-459. doi:10.1001/jama.1995.03530060031020