Opening a Dialogue about Medical Errors

Jun 29, 2015

New book addresses error reduction from an oncology-specific viewpoint

Oncology practitioners have a new resource for their quality-improvement arsenal: Clinical Oncology and Error Reduction, published in May 2015, is the first single-volume publication to address medical errors in the setting of cancer care. The book is co-edited by ASCO member Antonella Surbone, MD, PhD, FACP, of New York University, and Michael Rowe, PhD, of Yale School of Medicine. Intended as both a training tool and a think-piece, the book strikes a balance between providing valuable practical information and guidance and opening up a conversation about humanism, emotions, and relationships between providers and patients.

Dr. Surbone shared with ASCO Connection her insights about patient safety and medical errors and offered a glimpse into the history that led to this new publication.

AC: Why is it important to examine medical errors specifically in the context of clinical oncology, as you do in the book?

Dr. Surbone: The nature of cancer care  makes oncologists uniquely vulnerable to the difficulties associated with identifying, understanding, disclosing, and managing medical error and its aftermath. Because of this, along with the psychosocial repercussions of cancer on patients and their families, oncology as a specialty is also uniquely situated to provide medical leadership regarding medical error within and beyond its disciplinary boundaries to medicine. .

AC: As a specialist in oncology and bioethics, what unique perspective do you bring to the problem of medical errors?

Dr. Surbone: I graduated from medical school in Italy, and at the age of 24 I became a medical oncology fellow at the National Cancer Institute (NCI), Milan, under Dr. Gianni Bonadonna. This was the time of the first studies on adjuvant chemotherapy for breast cancer and combined treatment for Hodgkin and non-Hodgkin lymphomas. I could say that the first thing I learned was how to follow strict guidelines to avoid errors in experimental therapies.

After two years, I came to the United States as fellow at the NCI, then directed by Dr. Vincent T. DeVita, Jr., in the Medicine Branch; there, too, responsibility toward patients and patient safety came first. I recall all the many step-checks for each chemotherapy order that we wrote. As an Italian, for example, I used to write the numbers 4 and 7 differently from my U.S. colleagues, and almost always the nurse or pharmacist would come to me to double-check and have it rewritten. I was so impressed by the efficiency of this teamwork, and grateful for all the mistakes that were prevented by this strict Institutional and system control.

Still, from my 25  years of oncology practice as attending in New York at Memorial Sloan Kettering Cancer Center and then Bellevue Hospital, I had plenty of occasions to realize that errors were not only related to treatment prescription, but also involved our knowledge and judgment (what Aristotle called phronesis) as physicians in diagnosis and prognosis, as well as in communicating with our patients. Over the years, I became more aware of how oncology entails complex and multidisciplinary treatments, at times experimental, often involving concomitant anticancer and supportive therapies, different specialists and multiple patient-doctor relationships: this makes our patients especially vulnerable to medical errors.

As I earned a doctorate degree in philosophy at Fordham University, I started focusing on the ethical and social implications of global cancer care. I began exploring the philosophical nature of error and forgiveness, as well as the impact of medical errors on the patient-doctor relationship and the reciprocal trust that sustains it.