Do we have enough 'injidents'?

The practice of medicine can never be risk free. Taking risks leads, by definition, to accidents – it is behaviour that carries with it a probability of an adverse outcome. But there are also rewards for risk taking. Reducing risk-taking will reduce both accidents and the rewards: for example, the extremely risk averse regimes governing the development of new drugs increase their costs and delay their arrival. There is a part of the medical profession exemplified by the authors of the British Medical Journal editorial “BMJ bans ‘accidents’ ” that seeks to deny the risky nature of medicine. Their objection to the word accident is that it deflects blame: “when we use ‘accident,’ we exonerate from blame the person injured, the parent, the manager, the facility, the company, or ‘the system’.” They prefer a word they suggest “injident” (an injury producing incident) – that assigns blame. The obsession with finding someone to blame for every adverse outcome feeds the blame-litigation-compensation culture – the injident culture – and has led in just five years to a seven-fold increase in NHS payouts for clinical negligence. It encourages the practice of defensive medicine. Defensive medicine is medicine governed more by the fears of the doctor than the interests of the patient. It incurs costs – more risk assessments and unnecessary, and sometimes dangerous, diagnostic and exploratory procedures – and diverts resources from more effective applications. It is possible to have too few accidents – or “injidents” as the British Medical Journal might prefer to call them. On the 2 of June 2001 the British Medical Journal published an editorial with the title “BMJ bans ‘accidents’”. The authors explained: “most injuries and their precipitating events are predictable and preventable. That is why the BMJ has decided to ban accidents.” What word would they use in its stead? After considering and rejecting a number of alternatives they say “the English language may simply fail us here. Perhaps we should coin a word to refer collectively to the incidents that may produce injury (injidents?).” Their principal objection to the use of the word accident is that it deflects blame: “when we use ‘accident,’ we exonerate from blame the person injured, the parent, the manager, the facility, the company, or ‘the system’.” They should perhaps have pondered longer why a language as rich and ancient as English should lack a word adequate to their purpose. Their proposal loads the word “accident” with a bias that it does not have in common parlance. In everyday usage it is blame-neutral – it is simply an unfortunate, undesired and unintended event. They would replace it with a word that is blame-loaded every undesired outcome must be someone’s fault. (While they say “most” injidents are predictable and preventable, they are prepared to exonerate only those for which preventive or avoiding measures are impossible – perhaps asteroid impacts.) They may protest that their new word is neutral but words, especially new words, acquire their meanings from the contexts in which they are used, and the editors make clear in the 1 Barry Pless, editor of Injury Prevention, and Ron Davis, North American editor of the BMJ.