Clipping Board » Medical Myths ─ The truth about healthcare is often different from what you intuitively think.
2001-10, Issue 35 of Common Health Magazine
A 37-year-old man sought medical attention due to fatigue, dizziness, weakness in limbs, and coldness. The doctor diagnosed him with a cold but did not take his temperature, blood pressure, or pulse before administering an antibiotic injection. The next day, the patient died of cardiopulmonary failure. It was later discovered that he had myocarditis, not a cold.
* * *
An elderly woman sought treatment for anemia. During a blood transfusion, the doctor mistakenly gave her AB-type blood despite her being type O, leading to her death from kidney failure...
* * *
"First, do no harm." This was the foremost principle in the Hippocratic Oath, written by the father of Western medicine, Hippocrates, over two thousand years ago.
More than a year ago, the U.S. Institute of Medicine (IOM) released a report titled *To Err Is Human*, revealing that approximately 44,000 to 98,000 Americans die each year due to preventable medical errors—a shocking revelation for the nation.
Nearly 100,000 deaths equate to two Boeing 747 crashes every three days, with all 400 passengers perishing. Even the most conservative estimate of 44,000 deaths surpasses the eighth leading cause of death in the U.S., meaning more people die from medical errors than from car accidents, breast cancer, or AIDS.
How many people in Taiwan die due to medical errors or misdiagnoses during treatment?
Although there are no large-scale official studies or statistics in Taiwan, Ho Hsiao-chi, a graduate student at National Taiwan University's Institute of Health Policy and Management, used the formula from the IOM study to estimate the number of deaths caused by medical harm in Taiwan.
Based on the 2,151,792 acute care bed services in 1997, she estimated that between 2,911 and 6,281 people may have died from medical errors that year. Using a different definition from Australia, the death toll could be as high as 8,927.
What do these numbers signify?
Even the lowest estimate of 2,911 deaths would rank as the ninth leading cause of death that year, exceeding fatalities from hypertension and suicide.
Worryingly, this invisible killer may not just rank ninth.
"An estimated 5,000 to 10,000 people die each year due to medical errors or misdiagnoses—this may be a reasonable estimate," said Kuo Hsu-sung, former director of the Department of Planning at the Department of Health and ex-deputy dean of Yang-Ming University's School of Medicine. As for those harmed but not killed, "the number is likely even higher," he added.
Walking into a hospital, you expect medical professionals to heal you—only to find your condition worsening or even losing your life. Can you imagine?
Yang Hsiu-yi, an assistant professor in the Department of Health Care Management at Chang Gung University, pointed out that *To Err Is Human* exposed a long-unspoken reality in medicine: healthcare is far from safe. "This news may surprise us, but for doctors, they likely witness errors in hospitals every day."
Why has life-saving medicine become fraught with danger?
White Angels or Black Reapers?
First, modern medicine, despite its advanced technology and equipment, is not entirely scientific. Medicine itself is not absolute.
"Medical practice has one key characteristic: uncertainty," Kuo Hsu-sung noted. Even when doctors follow protocols and do their best, patients may still experience adverse outcomes that differ from others'. Many treatments inherently carry risks, varying from person to person.Not to mention medical personnel pushing patients into the arms of death due to negligence or errors.
A report by the U.S. Institute of Medicine found that more than half (58%) of medical injuries were caused by preventable mistakes by doctors, while the remaining 42% were unavoidable, such as a certain percentage of complications and infections.
In reality, nearly every step of the medical process involves human intervention. And where there is human involvement, mistakes are bound to happen.
From the moment you enter a hospital to register, not knowing which department to visit may delay treatment. During the brief two- to three-minute consultation, is the doctor’s diagnosis accurate? If the diagnosis is correct, is the prescribed medication appropriate? Did you receive the right medication, and are you taking it on time and in the correct dosage? If tests are required, did the lab technician mix up your records with another patient’s? In the operating room, do the medical staff know which part of your body needs surgery—will they operate on the left leg instead of mistakenly cutting the right one?
As healthcare organizations grow larger and responsibilities become more specialized, a single patient interacts with more medical personnel, increasing the likelihood of errors—especially when communication between doctors and patients is poor.
### Unique Work Environment
Certain characteristics of the medical environment also contribute to inevitable mistakes.
For example, frequent overtime work and high stress.
In large hospitals, a single doctor may see 50 to 60 outpatients in a day, with some even handling over a hundred. "How can there not be mistakes? Sometimes it’s just 'luck' that nothing goes wrong," admitted a well-known internal medicine professor.
In surgical departments, where medical errors are more common, overtime work is often the norm.
"Hospitals aren’t factory production lines—overtime doesn’t guarantee results," reflected Yeh Wen-ling, a trauma surgeon with over a decade of experience at Linkou Chang Gung Memorial Hospital.
Young resident doctors may have been on duty the night before, sleepless, only to rush into the operating room early the next morning. Exhausted, a momentary lapse—like accidentally dropping a clamp into a patient’s body—can lead to unnecessary harm or death. Such incidents are not unheard of.
In terms of nursing staff, the overnight shift from midnight to dawn may only have two or three nurses responsible for 20 to 30 patients. Yet, many patients in general wards in Taiwan rely on ventilators and require more attentive care, which they may not receive. Many hospitals, especially smaller ones, struggle to find qualified nurses. With so few willing to work in such conditions, "it’s often impossible to demand quality," observed a senior physician at a medical center.
Inadequate shift handover systems also plant a ticking time bomb in healthcare.
Three or four years ago, Chiang Chen-en, a cardiologist at Taipei Veterans General Hospital who trained in the U.S., noted that American hospitals meticulously handle pre-holiday shift handovers. On Friday evenings, attending physicians would personally visit each patient’s bedside to brief the next team. If an on-call doctor was needed at night, they had to rush in from home.
In contrast, Taiwan lacks strict accountability for attending physicians. Some turn off their pagers after leaving the hospital, making it difficult for the hospital to reach them if a patient has an emergency. Some hospitals don’t even list attending physicians’ pager numbers on the duty roster. If an inpatient has a crisis, the junior residents and interns may panic, unsure how to respond.
Medication errors are also common. With countless drugs available, some with similar names, mistakes by doctors, nurses, or pharmacists—prescribing the wrong drug, misreading labels, giving medication to the wrong patient, incorrect dosages, or improper administration—can cause irreparable harm.In China, the mother-in-law of a prominent entrepreneur went to the hospital for a gastroscopy. However, due to a mistake by the medical staff who gave her the wrong pre-examination oral solution, she immediately foamed at the mouth, lost consciousness, and became vegetative.
Additionally, the lack of domestic treatment guidelines, coupled with the National Health Insurance’s fee-for-service payment system that indirectly incentivizes excessive procedures, has led doctors to encourage patients to undergo unnecessary tests and surgeries—another hidden concern.
The Culture of Denying Mistakes
The process of seeking medical care is like a series of interlocking gears that must work seamlessly to function properly. If even one gear is missing a tooth or rusts and falls off, the entire mechanism will malfunction, potentially halting a patient’s life.
Yet, when this system fails, medical professionals often refuse to provide explanations to anxious and confused patients and their families. Typically, only those within the "medical circle"—hospitals, doctors, and nurses—are aware of the issue, while patients and their families remain in the dark. This forces the public to resort to protests at hospitals, carrying coffins, scattering funeral paper, or throwing eggs.
"If there’s a medical error, unless it’s truly impossible to hide, the tendency is to conceal it as much as possible and not inform the patient or their family," a surgeon from a major hospital candidly analyzed the current situation.
Why the Reluctance to Admit Mistakes?
For a long time, healthcare providers have been seen as godlike figures, fostering a culture where mistakes are not tolerated. Errors are viewed as signs of weakness or incompetence, creating a significant constraint.
After decades in medicine, Professor Zhu Naixin from the Department of Neurology at Linkou Chang Gung Memorial Hospital deeply feels that patients and their families hold unrealistically high expectations of doctors, demanding perfection. "In their minds, a good doctor never makes mistakes!" But the problem is, doctors are human—can they really never err?
Medical organizations are also highly hierarchical, emphasizing seniority and tradition.
"Hospitals lack a judicial system!" remarked a mid-career internist.
Especially in Asian societies, where respect for seniority is paramount, junior doctors entering the field—despite their ideals and passion—often witness unreasonable practices, particularly errors made by senior physicians. Yet, they can only bite their tongues and remain silent.
"Unless I want to leave this profession. In this world, you have no choice," one doctor lamented. Moreover, the doctor being discussed would feel "betrayed."
A neurosurgeon further pointed out that some patients who come to him for treatment had previously seen another doctor who failed to remove all of their tumors, perhaps only addressing a small portion. When these patients return months later with discomfort or complications, he can only remain silent and do his best to treat them, unwilling to point out the previous doctor’s mistake. "It’s a kind of professional code," the surgeon said with a resigned smile.
This unspoken rule of "not speaking up" is even rooted in a "there but for the grace of God go I" mentality—knowing that one could easily be the next to make a mistake.
Unlike in the U.S., the vast majority of medical disputes in Taiwan are handled under criminal law rather than civil law, meaning healthcare providers face criminal liability and potential imprisonment. This is a major reason why the medical community avoids discussing errors.
But when the focus remains solely on medical disputes, it’s like seeing the trees but missing the forest—addressing only the downstream consequences while ignoring the upstream medical errors.
Upstream Medical Errors Must Be Addressed First
"Many hospitals don’t talk about medical errors; they talk about how to avoid medical disputes," lamented Huang Dafu, president of Koo Foundation Sun Yat-Sen Cancer Center. The medical community has reversed cause and effect, failing to realize that without addressing errors, disputes will only multiply. "So far, the medical community hasn’t even considered sitting down to acknowledge medical errors and actively think about how to provide a safer healthcare environment," he sighed again.Even when medical errors are discussed, the medical community tends to address the issue by identifying "the person at fault" rather than adopting a "systemic" approach, which often fails to uncover the root cause.
"Don't oversimplify medical errors as the problem of 'one person,' thinking that removing someone will solve the issue," reminds Yang Hsiu-Yi, an assistant professor at Chang Gung University.
Unfortunately, healthcare professionals are on the front lines facing patients and their families. When something goes wrong, they are the first to bear the brunt of the blame, even if the error stems from flawed system design or hospital procedures. Often, they have no choice but to endure the unfair criticism in silence.
For example, an obstetrician at a medical center was delivering a baby when they noticed the newborn had breathing difficulties. The doctor immediately reached for an oxygen tank nearby, only to find it empty. The infant suffered severe damage due to oxygen deprivation. Although the doctor followed standard procedures, the hospital's management oversight led to the error. While the fault may not have been entirely theirs, the doctor still faced legal consequences.
In another medical center, a patient died from respiratory failure after their ventilator became detached. A young resident physician reported the incident during a departmental morning meeting, stating honestly on the death certificate that the patient "died due to ventilator detachment." Instead of earning praise for their honesty, the resident was met with laughter and criticism for "how could you write that?" No one bothered to question whether the patient truly died because of the detached ventilator or, if so, how the hospital could improve patient care.
Yang Hsiu-Yi, who has a background in law and healthcare management, frequently discusses "medical errors" during her invited lectures at major hospitals.
She has found that while many doctors find the topic interesting and do not resist it, the idea of self-reflection and accountability is another matter. "The attitude toward medical errors in Taiwan's medical community is one of indifference—it's seen as someone else's problem," Yang says with concern. "Taiwan's medical community is slow to respond. While we excel in medical technology, we lag behind in patient rights and safety, which is unacceptable."
Moving Forward in Medicine
Creating a safe medical environment is a responsibility the medical community must shoulder.
Chen Yu-Ruei, superintendent of Linkou Chang Gung Memorial Hospital, compares the entire medical staff in a hospital to the crew of an airplane, emphasizing the need for teamwork. Patients, like passengers, entrust their lives to the crew, expecting a safe journey. "This is a matter of medical quality—we must deliver," he stresses.
Pulling out his laptop, Chen Yu-Ruei types a few keys, and the screen displays Chang Gung Hospital's monthly medical quality indicators, including medication error rates, hospital-acquired infection rates, and transfusion error rates.
In addition to analyzing internal shortcomings monthly and quarterly, Linkou Chang Gung also collaborates with Taipei Veterans General Hospital and Taipei Mackay Memorial Hospital to compare quality benchmarks.
"If they perform better in certain areas, we should learn from them," Chen explains the rationale behind the collaboration.
Other hospitals are making similar efforts.
Chen Yen-Hui, who took over as director of the Department of Pharmacy at National Taiwan University Hospital less than a year ago, appears young and efficient. Upon assuming her role, she immediately initiated a program to track "prescription entry errors in outpatient and inpatient settings," analyzing the mistakes made by doctors each month.
After sharing the analyzed data with the respective departments, "some medication errors, which previously occurred seven or eight times a month, have now dropped to just one," Chen affirms the effectiveness of sharing prescription error information.
In the laboratory sector, recognizing that most labs—from national facilities to hospital departments—lack standardized procedures and fail to meet international requirements, efforts are also underway to address these gaps.There was a pregnant woman who was three months along. During a prenatal check-up at a major hospital, her human chorionic gonadotropin (hCG) levels were found to be abnormally high. Based on the report, the obstetrician concluded that the expectant mother either had an underdeveloped embryo, a molar pregnancy, or choriocarcinoma. Consequently, the pregnancy tissue was removed. However, when the tissue was later sent to the pathology department for confirmation, it turned out to be a normal embryo. The mistake was traced back to an error in the blood analysis procedure during testing, resulting in the tragic loss of an innocent life.
"Laboratories in Taiwan must adopt the concept of certification!" urgently emphasized Dr. Chi Wei-ming, Director of the Clinical Pathology Department at Tri-Service General Hospital.
As the chairman of the Taiwan Clinical Laboratory Standards Committee, Dr. Chi has spent the past five years actively promoting the establishment of national laboratory standards.
He joked that, thanks to the government's strong support for the biotechnology industry, efforts to promote laboratory certification have finally moved beyond the initial years of indifference and are gradually gaining some traction.
Although the medical community appears to be making some efforts toward improving healthcare quality, the depth of these efforts remains insufficient, according to Yang Hsiu-yi, a member of the Medical Review Committees in Taipei City and New Taipei City.
A renowned neurosurgery professor admitted that while hospitals hold meetings to discuss patient deaths and complications—sharing experiences to prevent repeated mistakes—the well-intentioned practice often backfires. Doctors who make errors feel targeted and exposed.
"Even when we discuss these matters behind closed doors, there's no foundation of mutual trust," the professor said. As a result, such discussions often skirt the real issues.
**Health Authorities Must Show Resolve**
On the other hand, health authorities should not remain passive on the issue of medical errors.
It wasn't until the end of May this year that the Department of Health (DOH) first published the results of medical dispute case reviews from 1987 to 1999, hoping to remind the medical community to avoid repeating past mistakes. A DOH official expressed concern, explaining that similar cases resulting in patient deaths keep recurring.
However, such efforts are clearly inadequate. Health authorities must demonstrate stronger resolve and do more.
One key measure is establishing a robust information system to effectively monitor healthcare quality.
"The Bureau of National Health Insurance (BNHI) and the DOH must release certain statistics," said Dr. Chen Yu-jui, a hospital superintendent. He believes that reducing medical errors cannot rely solely on hospitals—health authorities must also take action. "Both sides must push for change," he stressed.
Unlike in Taiwan, where the DOH and BNHI do not monitor or publish key data such as surgical success and mortality rates—leaving patients to rely on luck—the U.S. Medicare system began releasing hospital mortality rates in 1986. Similarly, the New York State Department of Health publishes cardiac surgery success rates for hospitals statewide, providing valuable information for patients.
Since New York implemented this system, doctors with poorer skills or higher error rates were forced out of practice. As a result, New York became an internationally renowned hub for cardiac surgery, attracting patients from around the world.
Dr. Chen Yu-jui believes that, especially since the BNHI is the payer, it has the manpower, insurance data, and a degree of public credibility to encourage healthcare institutions to improve and reduce medical errors.
Kuo Hsu-sung, Director of the DOH's Planning Division, also emphasized the necessity of establishing an information system. While the data provided may not be perfect, "withholding information leads to worse outcomes," he said, because patients seeking medical care are left to "blindly guess, rely on reputation, or flock to large hospitals."
As a graduate of the first class of Yangming Medical College and a former professor at National Yang-Ming University, Kuo often hears from doctor friends about "big-name doctors making serious mistakes." He laments the lack of information available to patients, leading them to make uninformed choices."The medical information is shrouded in darkness; we should light a lamp in the medical field," emphasized Kuo Hsu-sung.
**Creating an Environment that Encourages Admitting Mistakes**
However, when asking the medical field to face and admit mistakes, society should also provide an environment that encourages such admissions.
"There needs to be a mechanism in society that offers channels to encourage the medical field to discuss medical errors and negligence. Otherwise, there’s no solution," pointed out a concerned mid-career physician from National Taiwan University Hospital.
For example, when handling medical disputes, follow international practices by focusing on civil compensation rather than criminal prosecution.
"If we punish those who are honest, who would want to be honest?" analyzed Director Chen Yu-jui. For anyone, admitting mistakes is difficult, so society should appreciate and encourage such honesty. Not punishing honesty isn’t about encouraging mistakes but encouraging those who make mistakes to speak up so that problems can be better identified.
On the other hand, the public also needs to rationally understand the limits and risks of medicine—especially in a society where a culture of admitting mistakes is generally lacking.
"Today, if we want doctors to admit mistakes, we must also be prepared to 'forgive,' based on the understanding that making mistakes is human nature," reminded Yang Hsiu-yi. The public should make the medical field unafraid to admit mistakes, "so that society as a whole can study why mistakes happen and create room for improvement."
The possibility of improvement is to ensure a better medical environment for both the medical field and the public.
"Providing a safe environment for patients should become an institutional culture," pointed out Huang Ta-fu, president of Koo Foundation Sun Yat-Sen Cancer Center. Mistakes can be forgiven, "but they should never be forgotten!" The medical field must learn from these lessons and avoid repeating them.
When other high-risk industries, such as aerospace and nuclear energy, adopt scientific methods for risk management and error reduction, shouldn’t medicine—which deals with human lives—also abandon its lofty "ivory tower" image and approach medical errors with a scientific and managerial attitude?
Making mistakes is human nature, but Taiwan’s medical field should seriously reflect: Within understandable limits, have too many mistakes been made? Has there been management improvement?
Source: http:/ / www. commonhealth. com. ……le/ article. action? id=5026396
Don't Let the Hospital Kill You
A 37-year-old man sought medical attention due to fatigue, dizziness, weakness in limbs, and coldness. The doctor diagnosed him with a cold but did not take his temperature, blood pressure, or pulse before administering an antibiotic injection. The next day, the patient died of cardiopulmonary failure. It was later discovered that he had myocarditis, not a cold.
* * *
An elderly woman sought treatment for anemia. During a blood transfusion, the doctor mistakenly gave her AB-type blood despite her being type O, leading to her death from kidney failure...
* * *
"First, do no harm." This was the foremost principle in the Hippocratic Oath, written by the father of Western medicine, Hippocrates, over two thousand years ago.
More than a year ago, the U.S. Institute of Medicine (IOM) released a report titled *To Err Is Human*, revealing that approximately 44,000 to 98,000 Americans die each year due to preventable medical errors—a shocking revelation for the nation.
Nearly 100,000 deaths equate to two Boeing 747 crashes every three days, with all 400 passengers perishing. Even the most conservative estimate of 44,000 deaths surpasses the eighth leading cause of death in the U.S., meaning more people die from medical errors than from car accidents, breast cancer, or AIDS.
How many people in Taiwan die due to medical errors or misdiagnoses during treatment?
Although there are no large-scale official studies or statistics in Taiwan, Ho Hsiao-chi, a graduate student at National Taiwan University's Institute of Health Policy and Management, used the formula from the IOM study to estimate the number of deaths caused by medical harm in Taiwan.
Based on the 2,151,792 acute care bed services in 1997, she estimated that between 2,911 and 6,281 people may have died from medical errors that year. Using a different definition from Australia, the death toll could be as high as 8,927.
What do these numbers signify?
Even the lowest estimate of 2,911 deaths would rank as the ninth leading cause of death that year, exceeding fatalities from hypertension and suicide.
Worryingly, this invisible killer may not just rank ninth.
"An estimated 5,000 to 10,000 people die each year due to medical errors or misdiagnoses—this may be a reasonable estimate," said Kuo Hsu-sung, former director of the Department of Planning at the Department of Health and ex-deputy dean of Yang-Ming University's School of Medicine. As for those harmed but not killed, "the number is likely even higher," he added.
Walking into a hospital, you expect medical professionals to heal you—only to find your condition worsening or even losing your life. Can you imagine?
Yang Hsiu-yi, an assistant professor in the Department of Health Care Management at Chang Gung University, pointed out that *To Err Is Human* exposed a long-unspoken reality in medicine: healthcare is far from safe. "This news may surprise us, but for doctors, they likely witness errors in hospitals every day."
Why has life-saving medicine become fraught with danger?
White Angels or Black Reapers?
First, modern medicine, despite its advanced technology and equipment, is not entirely scientific. Medicine itself is not absolute.
"Medical practice has one key characteristic: uncertainty," Kuo Hsu-sung noted. Even when doctors follow protocols and do their best, patients may still experience adverse outcomes that differ from others'. Many treatments inherently carry risks, varying from person to person.Not to mention medical personnel pushing patients into the arms of death due to negligence or errors.
A report by the U.S. Institute of Medicine found that more than half (58%) of medical injuries were caused by preventable mistakes by doctors, while the remaining 42% were unavoidable, such as a certain percentage of complications and infections.
In reality, nearly every step of the medical process involves human intervention. And where there is human involvement, mistakes are bound to happen.
From the moment you enter a hospital to register, not knowing which department to visit may delay treatment. During the brief two- to three-minute consultation, is the doctor’s diagnosis accurate? If the diagnosis is correct, is the prescribed medication appropriate? Did you receive the right medication, and are you taking it on time and in the correct dosage? If tests are required, did the lab technician mix up your records with another patient’s? In the operating room, do the medical staff know which part of your body needs surgery—will they operate on the left leg instead of mistakenly cutting the right one?
As healthcare organizations grow larger and responsibilities become more specialized, a single patient interacts with more medical personnel, increasing the likelihood of errors—especially when communication between doctors and patients is poor.
### Unique Work Environment
Certain characteristics of the medical environment also contribute to inevitable mistakes.
For example, frequent overtime work and high stress.
In large hospitals, a single doctor may see 50 to 60 outpatients in a day, with some even handling over a hundred. "How can there not be mistakes? Sometimes it’s just 'luck' that nothing goes wrong," admitted a well-known internal medicine professor.
In surgical departments, where medical errors are more common, overtime work is often the norm.
"Hospitals aren’t factory production lines—overtime doesn’t guarantee results," reflected Yeh Wen-ling, a trauma surgeon with over a decade of experience at Linkou Chang Gung Memorial Hospital.
Young resident doctors may have been on duty the night before, sleepless, only to rush into the operating room early the next morning. Exhausted, a momentary lapse—like accidentally dropping a clamp into a patient’s body—can lead to unnecessary harm or death. Such incidents are not unheard of.
In terms of nursing staff, the overnight shift from midnight to dawn may only have two or three nurses responsible for 20 to 30 patients. Yet, many patients in general wards in Taiwan rely on ventilators and require more attentive care, which they may not receive. Many hospitals, especially smaller ones, struggle to find qualified nurses. With so few willing to work in such conditions, "it’s often impossible to demand quality," observed a senior physician at a medical center.
Inadequate shift handover systems also plant a ticking time bomb in healthcare.
Three or four years ago, Chiang Chen-en, a cardiologist at Taipei Veterans General Hospital who trained in the U.S., noted that American hospitals meticulously handle pre-holiday shift handovers. On Friday evenings, attending physicians would personally visit each patient’s bedside to brief the next team. If an on-call doctor was needed at night, they had to rush in from home.
In contrast, Taiwan lacks strict accountability for attending physicians. Some turn off their pagers after leaving the hospital, making it difficult for the hospital to reach them if a patient has an emergency. Some hospitals don’t even list attending physicians’ pager numbers on the duty roster. If an inpatient has a crisis, the junior residents and interns may panic, unsure how to respond.
Medication errors are also common. With countless drugs available, some with similar names, mistakes by doctors, nurses, or pharmacists—prescribing the wrong drug, misreading labels, giving medication to the wrong patient, incorrect dosages, or improper administration—can cause irreparable harm.In China, the mother-in-law of a prominent entrepreneur went to the hospital for a gastroscopy. However, due to a mistake by the medical staff who gave her the wrong pre-examination oral solution, she immediately foamed at the mouth, lost consciousness, and became vegetative.
Additionally, the lack of domestic treatment guidelines, coupled with the National Health Insurance’s fee-for-service payment system that indirectly incentivizes excessive procedures, has led doctors to encourage patients to undergo unnecessary tests and surgeries—another hidden concern.
The Culture of Denying Mistakes
The process of seeking medical care is like a series of interlocking gears that must work seamlessly to function properly. If even one gear is missing a tooth or rusts and falls off, the entire mechanism will malfunction, potentially halting a patient’s life.
Yet, when this system fails, medical professionals often refuse to provide explanations to anxious and confused patients and their families. Typically, only those within the "medical circle"—hospitals, doctors, and nurses—are aware of the issue, while patients and their families remain in the dark. This forces the public to resort to protests at hospitals, carrying coffins, scattering funeral paper, or throwing eggs.
"If there’s a medical error, unless it’s truly impossible to hide, the tendency is to conceal it as much as possible and not inform the patient or their family," a surgeon from a major hospital candidly analyzed the current situation.
Why the Reluctance to Admit Mistakes?
For a long time, healthcare providers have been seen as godlike figures, fostering a culture where mistakes are not tolerated. Errors are viewed as signs of weakness or incompetence, creating a significant constraint.
After decades in medicine, Professor Zhu Naixin from the Department of Neurology at Linkou Chang Gung Memorial Hospital deeply feels that patients and their families hold unrealistically high expectations of doctors, demanding perfection. "In their minds, a good doctor never makes mistakes!" But the problem is, doctors are human—can they really never err?
Medical organizations are also highly hierarchical, emphasizing seniority and tradition.
"Hospitals lack a judicial system!" remarked a mid-career internist.
Especially in Asian societies, where respect for seniority is paramount, junior doctors entering the field—despite their ideals and passion—often witness unreasonable practices, particularly errors made by senior physicians. Yet, they can only bite their tongues and remain silent.
"Unless I want to leave this profession. In this world, you have no choice," one doctor lamented. Moreover, the doctor being discussed would feel "betrayed."
A neurosurgeon further pointed out that some patients who come to him for treatment had previously seen another doctor who failed to remove all of their tumors, perhaps only addressing a small portion. When these patients return months later with discomfort or complications, he can only remain silent and do his best to treat them, unwilling to point out the previous doctor’s mistake. "It’s a kind of professional code," the surgeon said with a resigned smile.
This unspoken rule of "not speaking up" is even rooted in a "there but for the grace of God go I" mentality—knowing that one could easily be the next to make a mistake.
Unlike in the U.S., the vast majority of medical disputes in Taiwan are handled under criminal law rather than civil law, meaning healthcare providers face criminal liability and potential imprisonment. This is a major reason why the medical community avoids discussing errors.
But when the focus remains solely on medical disputes, it’s like seeing the trees but missing the forest—addressing only the downstream consequences while ignoring the upstream medical errors.
Upstream Medical Errors Must Be Addressed First
"Many hospitals don’t talk about medical errors; they talk about how to avoid medical disputes," lamented Huang Dafu, president of Koo Foundation Sun Yat-Sen Cancer Center. The medical community has reversed cause and effect, failing to realize that without addressing errors, disputes will only multiply. "So far, the medical community hasn’t even considered sitting down to acknowledge medical errors and actively think about how to provide a safer healthcare environment," he sighed again.Even when medical errors are discussed, the medical community tends to address the issue by identifying "the person at fault" rather than adopting a "systemic" approach, which often fails to uncover the root cause.
"Don't oversimplify medical errors as the problem of 'one person,' thinking that removing someone will solve the issue," reminds Yang Hsiu-Yi, an assistant professor at Chang Gung University.
Unfortunately, healthcare professionals are on the front lines facing patients and their families. When something goes wrong, they are the first to bear the brunt of the blame, even if the error stems from flawed system design or hospital procedures. Often, they have no choice but to endure the unfair criticism in silence.
For example, an obstetrician at a medical center was delivering a baby when they noticed the newborn had breathing difficulties. The doctor immediately reached for an oxygen tank nearby, only to find it empty. The infant suffered severe damage due to oxygen deprivation. Although the doctor followed standard procedures, the hospital's management oversight led to the error. While the fault may not have been entirely theirs, the doctor still faced legal consequences.
In another medical center, a patient died from respiratory failure after their ventilator became detached. A young resident physician reported the incident during a departmental morning meeting, stating honestly on the death certificate that the patient "died due to ventilator detachment." Instead of earning praise for their honesty, the resident was met with laughter and criticism for "how could you write that?" No one bothered to question whether the patient truly died because of the detached ventilator or, if so, how the hospital could improve patient care.
Yang Hsiu-Yi, who has a background in law and healthcare management, frequently discusses "medical errors" during her invited lectures at major hospitals.
She has found that while many doctors find the topic interesting and do not resist it, the idea of self-reflection and accountability is another matter. "The attitude toward medical errors in Taiwan's medical community is one of indifference—it's seen as someone else's problem," Yang says with concern. "Taiwan's medical community is slow to respond. While we excel in medical technology, we lag behind in patient rights and safety, which is unacceptable."
Moving Forward in Medicine
Creating a safe medical environment is a responsibility the medical community must shoulder.
Chen Yu-Ruei, superintendent of Linkou Chang Gung Memorial Hospital, compares the entire medical staff in a hospital to the crew of an airplane, emphasizing the need for teamwork. Patients, like passengers, entrust their lives to the crew, expecting a safe journey. "This is a matter of medical quality—we must deliver," he stresses.
Pulling out his laptop, Chen Yu-Ruei types a few keys, and the screen displays Chang Gung Hospital's monthly medical quality indicators, including medication error rates, hospital-acquired infection rates, and transfusion error rates.
In addition to analyzing internal shortcomings monthly and quarterly, Linkou Chang Gung also collaborates with Taipei Veterans General Hospital and Taipei Mackay Memorial Hospital to compare quality benchmarks.
"If they perform better in certain areas, we should learn from them," Chen explains the rationale behind the collaboration.
Other hospitals are making similar efforts.
Chen Yen-Hui, who took over as director of the Department of Pharmacy at National Taiwan University Hospital less than a year ago, appears young and efficient. Upon assuming her role, she immediately initiated a program to track "prescription entry errors in outpatient and inpatient settings," analyzing the mistakes made by doctors each month.
After sharing the analyzed data with the respective departments, "some medication errors, which previously occurred seven or eight times a month, have now dropped to just one," Chen affirms the effectiveness of sharing prescription error information.
In the laboratory sector, recognizing that most labs—from national facilities to hospital departments—lack standardized procedures and fail to meet international requirements, efforts are also underway to address these gaps.There was a pregnant woman who was three months along. During a prenatal check-up at a major hospital, her human chorionic gonadotropin (hCG) levels were found to be abnormally high. Based on the report, the obstetrician concluded that the expectant mother either had an underdeveloped embryo, a molar pregnancy, or choriocarcinoma. Consequently, the pregnancy tissue was removed. However, when the tissue was later sent to the pathology department for confirmation, it turned out to be a normal embryo. The mistake was traced back to an error in the blood analysis procedure during testing, resulting in the tragic loss of an innocent life.
"Laboratories in Taiwan must adopt the concept of certification!" urgently emphasized Dr. Chi Wei-ming, Director of the Clinical Pathology Department at Tri-Service General Hospital.
As the chairman of the Taiwan Clinical Laboratory Standards Committee, Dr. Chi has spent the past five years actively promoting the establishment of national laboratory standards.
He joked that, thanks to the government's strong support for the biotechnology industry, efforts to promote laboratory certification have finally moved beyond the initial years of indifference and are gradually gaining some traction.
Although the medical community appears to be making some efforts toward improving healthcare quality, the depth of these efforts remains insufficient, according to Yang Hsiu-yi, a member of the Medical Review Committees in Taipei City and New Taipei City.
A renowned neurosurgery professor admitted that while hospitals hold meetings to discuss patient deaths and complications—sharing experiences to prevent repeated mistakes—the well-intentioned practice often backfires. Doctors who make errors feel targeted and exposed.
"Even when we discuss these matters behind closed doors, there's no foundation of mutual trust," the professor said. As a result, such discussions often skirt the real issues.
**Health Authorities Must Show Resolve**
On the other hand, health authorities should not remain passive on the issue of medical errors.
It wasn't until the end of May this year that the Department of Health (DOH) first published the results of medical dispute case reviews from 1987 to 1999, hoping to remind the medical community to avoid repeating past mistakes. A DOH official expressed concern, explaining that similar cases resulting in patient deaths keep recurring.
However, such efforts are clearly inadequate. Health authorities must demonstrate stronger resolve and do more.
One key measure is establishing a robust information system to effectively monitor healthcare quality.
"The Bureau of National Health Insurance (BNHI) and the DOH must release certain statistics," said Dr. Chen Yu-jui, a hospital superintendent. He believes that reducing medical errors cannot rely solely on hospitals—health authorities must also take action. "Both sides must push for change," he stressed.
Unlike in Taiwan, where the DOH and BNHI do not monitor or publish key data such as surgical success and mortality rates—leaving patients to rely on luck—the U.S. Medicare system began releasing hospital mortality rates in 1986. Similarly, the New York State Department of Health publishes cardiac surgery success rates for hospitals statewide, providing valuable information for patients.
Since New York implemented this system, doctors with poorer skills or higher error rates were forced out of practice. As a result, New York became an internationally renowned hub for cardiac surgery, attracting patients from around the world.
Dr. Chen Yu-jui believes that, especially since the BNHI is the payer, it has the manpower, insurance data, and a degree of public credibility to encourage healthcare institutions to improve and reduce medical errors.
Kuo Hsu-sung, Director of the DOH's Planning Division, also emphasized the necessity of establishing an information system. While the data provided may not be perfect, "withholding information leads to worse outcomes," he said, because patients seeking medical care are left to "blindly guess, rely on reputation, or flock to large hospitals."
As a graduate of the first class of Yangming Medical College and a former professor at National Yang-Ming University, Kuo often hears from doctor friends about "big-name doctors making serious mistakes." He laments the lack of information available to patients, leading them to make uninformed choices."The medical information is shrouded in darkness; we should light a lamp in the medical field," emphasized Kuo Hsu-sung.
**Creating an Environment that Encourages Admitting Mistakes**
However, when asking the medical field to face and admit mistakes, society should also provide an environment that encourages such admissions.
"There needs to be a mechanism in society that offers channels to encourage the medical field to discuss medical errors and negligence. Otherwise, there’s no solution," pointed out a concerned mid-career physician from National Taiwan University Hospital.
For example, when handling medical disputes, follow international practices by focusing on civil compensation rather than criminal prosecution.
"If we punish those who are honest, who would want to be honest?" analyzed Director Chen Yu-jui. For anyone, admitting mistakes is difficult, so society should appreciate and encourage such honesty. Not punishing honesty isn’t about encouraging mistakes but encouraging those who make mistakes to speak up so that problems can be better identified.
On the other hand, the public also needs to rationally understand the limits and risks of medicine—especially in a society where a culture of admitting mistakes is generally lacking.
"Today, if we want doctors to admit mistakes, we must also be prepared to 'forgive,' based on the understanding that making mistakes is human nature," reminded Yang Hsiu-yi. The public should make the medical field unafraid to admit mistakes, "so that society as a whole can study why mistakes happen and create room for improvement."
The possibility of improvement is to ensure a better medical environment for both the medical field and the public.
"Providing a safe environment for patients should become an institutional culture," pointed out Huang Ta-fu, president of Koo Foundation Sun Yat-Sen Cancer Center. Mistakes can be forgiven, "but they should never be forgotten!" The medical field must learn from these lessons and avoid repeating them.
When other high-risk industries, such as aerospace and nuclear energy, adopt scientific methods for risk management and error reduction, shouldn’t medicine—which deals with human lives—also abandon its lofty "ivory tower" image and approach medical errors with a scientific and managerial attitude?
Making mistakes is human nature, but Taiwan’s medical field should seriously reflect: Within understandable limits, have too many mistakes been made? Has there been management improvement?
Source: http:/ / www. commonhealth. com. ……le/ article. action? id=5026396