The dependencies in the procedure have to be anticipated and analyzed, the probabilities of component failure have to be reduced, and redundancies and backups must be built in. Computers and software should be used in prescribing drugs, in recording patient histories and wherever else is appropriate.
These and the other efforts recommended in “To Err Is Human” have little to do with medicine and much to do with operations research and systems theory.
Let’s help insure that these recommendations are implemented by making the following New Year’s resolution: Let news coverage of every plane crash remind us of the tens of thousands of almost invisible deaths due each year to medical error.
The story of these deaths and of the systematic errors that lead to them is harder to cover but more important than that of the random plane crashes that so intrigue us.
Professor of mathematics at Temple University, John Allen Paulos is the author of several books, including A Mathematician Reads the Newspaper and Once Upon a Number. His Who’s Counting? column on ABCNEWS.com appears on the first day of every month.