Perceived Medical Error in Primary Care: Physicians’ remorse and patients’ view —The need for a moral perspective in the analysis of medical harm

Background Reducing medical errors will improve health care quality, though few studies have addressed errors in Japan. We investigated primary care physicians’ medical errors and perceived causes. We compared the results with previously reported U.S. data. Methods Using a semi-structured instrument, we interviewed Japanese physicians about their most memorable medical errors and the perceived causes. We qualitatively analyzed interview transcripts to describe the errors and causes using a taxonomy including the categories: clinician factors, communication factors, administration factors, blunt-end factors, and patient-related factors. Results Thirty-three Japanese primary care practitioners participated. Of 37 reported cases, 15 occurred in hospitals, and 22 occurred as outpatients. Misdiagnoses (n 10) and procedural complications (n 7) were the most commonly reported errors. The most commonly reported causes included being hurried/busy (n 19), underestimating the patient’s condition (n 13), lack of follow-up (n 12) and being distracted (n 10). Cost and legal issues were raised as concerns less than in a similar U.S. study. Conclusions The most common memorable medical errors reported by Japanese physicians included misdiagnoses and procedural complications. The causes of being hurried and lacking knowledge were found in similar proportions to a previous U.S. study. Socio-cultural differences between Japan and the U.S. such as legal and insurance system differences appear to influence physicians’ perceptions of medical errors. These data demonstrate that serious medical errors occur in both inpatient and outpatient settings in Japan, and that primary care physicians can recognize and will discuss their errors. Further research is needed on epidemiology of and prevention of medical errors in Japan.