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December 21, 1994

Error in Medicine

Author Affiliations

From the Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass.

JAMA. 1994;272(23):1851-1857. doi:10.1001/jama.1994.03520230061039

FOR YEARS, medical and nursing students have been taught Florence Nightingale's dictum—first, do no harm.1 Yet evidence from a number of sources, reported over several decades, indicates that a substantial number of patients suffer treatment-caused injuries while in the hospital.2-6

In 1964 Schimmel2 reported that 20% of patients admitted to a university hospital medical service suffered iatrogenic injury and that 20% of those injuries were serious or fatal. Steel et al3 found that 36% of patients admitted to a university medical service in a teaching hospital suffered an iatrogenic event, of which 25% were serious or life threatening. More than half of the injuries were related to use of medication.3 In 1991 Bedell et al4 reported the results of an analysis of cardiac arrests at a teaching hospital. They found that 64% were preventable. Again, inappropriate use of drugs was the leading cause of

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