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June 12, 2002

Putting the Patient in Patient SafetyLinking Patient Complaints and Malpractice Risk

JAMA. 2002;287(22):3003-3005. doi:10.1001/jama.287.22.3003

The quintessential service business can be identified by a sign mounted prominently behind the counter proclaiming that "The Customer Is Always Right." Despite the lip service paid these days to consumer sovereignty and patient autonomy, however, it is hard to imagine a similar placard in a hospital or doctor's office reading "The Patient Is Always Right."

Consider medical error. For decades, error has been addressed primarily through malpractice litigation, the availability of which often depends on the lobbying muscle brought to bear by organized medicine, on one side, and the trial bar, on the other. Whether in the courts or the legislatures, patients rarely speak, but are spoken for. Following the publication in 1999 of the Institute of Medicine's report, To Err Is Human, it has become fashionable to think of error prevention as a cooperative, system-based pursuit of improvement rather than the identification and discipline of individual bad apples.1 This process, however, is typically framed as an exclusively professional one. Again, the patient is often the object of discussion and seldom the discussant.

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