Mistakes as a social construct: an historical approach

The Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in November 1999. The report focused public attention on the errors that occur within the medical system that cause death and harm to patients. It outlined a series of changes for health care that are aimed at reducing these errors by 50 percent over the next five years.This paper examines the problem of medical mistakes historically. It documents how legal, scientific, and medical trends during the years 1890-1934 intersected to effect the reporting of mistakes in the subspecialty of neurosurgery. At the start of this timeframe, mistakes were reported openly in journal articles as an educational tool. By its end, however, mistakes had gone "underground" and were buried amid a more objective, scientific reporting system. Using this historical perspective as a baseline, the paper concludes by re-examining the IOM's suggestions for change and comments on what they mean for the culture of medicine.