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GEORGE A. WILLIAMS, MD, OMIC Board of Directors

As a lifelong Chicago Cubs fan, I understand the topic of errors better than most folks. Sometimes errors are the individual’s fault. Sometimes, they are the team’s fault. I can’t count the number of times I’ve seen a routine pop fly drop among three Cubs players in a classic example of “I got it. You
take it.” Similarly, errors in medicine can be the fault of the individual or the fault of the team. The difference is that unlike in baseball, medical errors truly matter.

This issue of the Digest summarizes OMIC’s experience with diagnostic errors in pediatric patients. My thanks to Anne Menke and Bob Wiggins for providing these excellent examples of OMIC’s continuing quest to improve care.

It is a sobering report at multiple levels. First and foremost, it is a story of lost opportunity to prevent visual loss or even death in a child—an always tragic occurrence. Second, it demonstrates the personal consequences to the involved ophthalmologists, who are often devastated by the realization that their care has been judged to be negligent. Finally, and frankly least importantly, we see the substantial financial ramifications of such errors.

When I say the financial costs are the least important part of the story, it is not because the money does not matter. It does. Your Board carefully considers our fiduciary responsibility to our insureds on every settlement. Fortunately, OMIC has the financial strength to provide appropriate and fair compensation when patients have been harmed due to negligence. The most important issue is to understand what went wrong.

Each of these cases presents an opportunity to ask two important questions: How did this happen and what can be done to prevent it from happening again? Sometimes, it is simple physician error. We all make mistakes and in the current era of increasing patient volumes, increasing clinical knowledge to be mastered, and the often maddening regulatory and documentation requirements, I don’t see practice getting any easier. That makes it all the more important that we take the time to ask ourselves how sure we are of a diagnosis and to think what else could this be, particularly when managing an atypical presentation or clinical course. If we are not certain, close follow-up and a second opinion demonstrate to the patient our concern.

As noted by Bob and Anne, sometimes the answer is a systems-based failure. Medicine is transitioning to a future of team-based care in which systems of care will become increasingly critical. Nowhere in ophthalmology is this more apparent than in the management of ROP.

Several years ago, OMIC’s claim experience in retinopathy of prematurity demonstrated the need to approach ROP from a systems-based perspective. As a result, OMIC developed an evidence-based underwriting process that establishes a rigorous educational program involving not only ophthalmologists, but their offices and neonatal intensive care units as well. We call this process our “Safety Net” and if we can catch even one child, everyone wins. The Safety Net is a dynamic, evolving process and OMIC provides it free to everyone whether an OMIC insured or not. Under the direction of pediatric ophthalmologist Robert S. Gold, the OMIC ROP Task Force is continually evaluating
the Safety Net to reflect the best available evidence for the diagnosis and management of ROP. It is another example of the synergy between good medicine and good business.

I am told that this year is different for the Cubs. I hope so. One thing that will not be different is your company’s continuing dedication to patient safety. Baseball players often shrug off their errors with the attitude that they will get the next one. For our patients, there is no next one. I got it, you
 take it is no way to play ball or practice medicine.