Recent studies have documented evidence of injuries and deaths in hospitals due to medical errors. This article situates these developments in wider historical contexts.
A widely quoted saying within the medical profession (and often attributed to Hippocrates) is the aphorism: first, do no harm. In recent years, this ethical admonition has become increasingly relevant given the well-documented instances of physician-induced (or iatrogenic) injury, especially in a hospital setting. As the Institute of Medicine reported in a study published six years ago, between 44,000 and 98,000 Americans die each year as a result of medical errors that occur in hospitals. Even assuming that the lower figure is accurate, the results still mean that more people die in a given year from medical errors than from motor vehicle accidents, breast cancer, or AIDS. More recently, the United States federal government has estimated the figure to be at the higher end of that estimate--around 100,000.
The fact that these deaths occur in a hospital setting is, from a historical point of view, ironic. Many hospitals were founded in the medieval period and were seen as largely charitable institutions designed to care for the poor. Only in the second half of the 19th century were hospitals transformed into their modern form. As the sociologist Paul Starr observed in his Pulitzer prize winning book The Social Transformation of American Medicine,
"Few institutions have undergone as radical a metamorphosis as have hospitals in their modern history. In developing from places of dreaded impurity and exiled human wreckage into awesome citadels of science and bureaucratic order, they acquired a new moral identity, as well as new purposes and patients of higher status."
Historical writers such as Starr and others usually attribute this transformation primarily to two developments
1) The development of modern nursing pioneered by Florence Nightingale during the Crimean War--these professionally trained nurses could now handle the day-to-day management of patients in a hospital setting.
2) The rise in prestige of surgery--with the development of anesthesia as a way to make surgery less painful coupled with the view that surgery should be performed in an antiseptic environment (associated with the work of the English surgeon Joseph Lister), the hospital emerged as the primary venue in which surgical operations would be performed.
Despite these impressive technological developments in the fields of anesthesia and antiseptic (later aseptic) surgery, one aspect of the hospital environment has proven to be more difficult to “engineer”—namely, the human element; even in the 21st century, every medical and surgical procedure carried out in a hospital setting must still be “directed” (at some level) by a fallible human being. Recent news stories in both the print and broadcast media have highlighted how the elimination of medical errors in the future will require more focus on the human sources of these errors.
