The promise every doctor makes is "First, do no harm."  But doctors and hospitals do make mistakes. And the November 30 shocking report from the Institute of Medicine showed medical mistakes are a common and potentially life-threatening risk. If medical mistakes counted among the leading causes of death in America, they would be eighth.

Surgical gaffes like amputating the wrong foot or a deadly chemotherapy overdose make headlines. But patients may never hear of the more subtle errors, like a delay in diagnosis or testing that costs precious time to fight off disease. Medical mistakes costing lives. Medical mistakes are a stunningly huge problem, says a new report by the Institute of Medicine. It quoted studies estimating that at least 44,000 and perhaps as many as 98,000 hospitalized Americans die every year from errors. To put that into sharper and more alarming perspective, even the lower figure of 44,000 deaths exceeds the number of people who die each year either on the highways, of breast cancer or of AIDS.

It is an intolerable situation, especially when it's taking place in the United States, which leads the world in medical advances. The cause, according to the Institute of Medicine, is not as much recklessness on the part of doctors, nurses and other health providers as it is basic flaws in the way hospitals, clinics and pharmacies operate. That kind of problem is fixable.

As a matter of fact, safeguards have already been implemented to reduce the likelihood of such lethal medical errors. Some hospitals are now using computerized prescriptions to ensure that pharmacists don't misread doctors' scrawled prescriptions. At the urging of anesthesiologists, anesthesia equipment is being standardized. And the Food and Drug Administration is trying to reduce confusion by ensuring that the names of new drugs don't sound too similar to drugs already on the market.

Doctors' notoriously poor handwriting too often leaves pharmacists squinting to decipher a dose C was it 10 milligrams or 10 micrograms? C or even the name of the prescribed drug. Too many drug names sound confusingly alike. Consider the painkiller Celebrex and the anti-seizure drug Cerebyx; or Narcan, which treats morphine overdoses, and Norcuron, which can paralyze breathing muscles.

But far more is needed: a concerted and comprehensive effort to raise the bar on consumer safety in the health care industry, not unlike what has already taken place in other industries. Since many doctors already feel beleaguered by financial constraints imposed on their care, insurers and health maintenance organizations must also bear the burden of improving safety.

At a minimum, the Institute of Medicine wants to reduce medical errors by half within five years. Considering the number of people who die each year in hospitals - where they presumably go to get better - even that goal may be too conservative.

Keeping Up with Changes

Health care is a decade behind other high-risk industries in improving safety, the report said. It pointed to the transportation industry as a model: Just as engineers design cars so they cannot start in reverse, and airlines limit pilots' flying time to keep them rested, so can health care be improved. Some fixes already are under way: Some hospitals have computerized prescriptions. The Food and Drug Administration is hunting ways to catch sound-a-like drugs.

Anesthesiologists persuaded many manufacturers to standardize equipment and thus decreased technology-caused errors. Many doctors now literally mark the spot of surgical incisions before patients are put to sleep, so everyone agrees on what will be cut.

Changes Coming from Congress

The Institute of Medicine is part of the National Academy of Sciences, a private organization chartered by Congress to advise the government on scientific matters. Congress just passed legislation ordering the Agency for Health Care Policy and Research to hunt strategies to reduce medical mistakes. The bill will even change the name to the Agency for Healthcare Research and Quality to reflect the emphasis. President Clinton is expected to sign the bill soon. But the Institute of Medicine said reducing medical mistakes requires a bigger commitment.

It recommended that Congress should establish a federal Center for Patient Safety. It would require $35 million to start and should eventually spend $100 million a year in safety research.

The report said the total cost of medical mistakes, lost income and production, cost of disability and health care, totals $17 to 29 billion a year.

And thatís not mentioning the human toll. The government should require that hospitals, and eventually other health organizations, report all serious mistakes to state agencies so experts can detect patterns of problems and take action. About 20 states now require error reporting.

But how much and what penalties they impose varies widely. State licensing boards and medical accreditors should periodically re-examine health practitioners for competence, stressing safety practices. Standardized medical equipment and treatment guidelines can help doctors keep up. Change the ìculture of secrecyî that surrounds medical mistakes, encouraging doctors to discuss errors as well as near misses so problems are fixed.

But is there something you can do, even from your sickbed, to protect yourself?

Become an Expert

First, know what ails you. Ask your doctor all about it. Research it on the Internet, for instance. Patients should feel entitled to inquire about their care no matter how sick they are. Second, know about your drugs. The study shows more than 7,000 die each year because of medication errors.

Kohn L, ed, Corrigan J, ed, Donaldson M, ed. To Err Is Human: Building a Safer Health System.

Washington, DC: National Academy Press; 1999