Editing Medical error (section)

== Causes ==
{{See also|Healthcare error proliferation model}}

The research literature showed that medical errors are caused by errors of commission and errors of omission.<ref name="Clapper 2020 74–81">{{Cite journal|last1=Clapper|first1=Timothy C.|last2=Ching|first2=Kevin|year=2020|title=Debunking the myth that the majority of medical errors are attributed to communication|journal=Medical Education|language=en|volume=54|issue=1|pages=74–81|doi=10.1111/medu.13821|pmid=31509277|issn=1365-2923|doi-access=free}}</ref> Errors of omission are made when providers did not take action when they should have, while errors of commission occur when decisions and action are delayed.<ref name="Clapper 2020 74–81"/> A special form of an error of commission occurs when health care professionals commit to unnecessary treatment in the case of [[Medical child abuse]] (Munchausen syndrome by proxy). Commission and omission errors have also been attributed with communication failures.<ref name="De Gruyter">{{Cite book|last1=Hannawa|first1=Annegret|url=https://www.degruyter.com/document/doi/10.1515/9783110454857/html|title=New Horizons in Patient Safety: Safe Communication: Evidence-based core Competencies with Case Studies from Nursing Practice|last2=Wendt|first2=Anne|last3=Day|first3=Lisa J.|date=2017-12-04|publisher=De Gruyter|isbn=978-3-11-045485-7|doi=10.1515/9783110454857|access-date=April 21, 2021|archive-date=April 21, 2021|archive-url=https://web.archive.org/web/20210421212531/https://www.degruyter.com/document/doi/10.1515/9783110454857/html|url-status=live}}</ref><ref name="degruyter.com">{{Cite book|last1=Hannawa|first1=Annegret|url=https://www.degruyter.com/document/doi/10.1515/9783110455014/html|title=New Horizons in Patient Safety: Understanding Communication: Case Studies for Physicians|last2=Wu|first2=Albert|last3=Juhasz|first3=Robert|date=2017-03-06|publisher=De Gruyter|isbn=978-3-11-045501-4|doi=10.1515/9783110455014|access-date=April 21, 2021|archive-date=August 14, 2024|archive-url=https://web.archive.org/web/20240814204244/https://www.degruyter.com/document/doi/10.1515/9783110455014/html|url-status=live}}</ref>

A study with data from 67 826 patients found that poor communication was the only identifiable cause of 1 in 10 patient safety incidents, and that poor communication contributes to 25% of patient safety incidents.<ref>{{cite journal |last1=Keshtkar |first1=L |last2=Bennett-Weston |first2=A |last3=Khan |first3=AS |last4=Mohan |first4=S |last5=Jones |first5=M |last6=Nockels |first6=K |last7=Gunn |first7=S |last8=Armstrong |first8=N |last9=Bostock |first9=J |last10=Howick |first10=J |title=Impacts of Communication Type and Quality on Patient Safety Incidents: A Systematic Review |journal=Annals of Internal Medicine |date=15 April 2025 |doi=10.7326/ANNALS-24-02904 |pmid=40228297}}</ref>

Medical errors can be associated with inexperienced physicians and nurses, new procedures, extremes of age, and complex or urgent care.<ref>{{cite journal |last1=Harrison |first1=Bernadette |last2=Gibberd |first2=Robert W. |last3=Wilson |first3=Ross McL |last4=Weingart |first4=N. Saul |title=Epidemiology of medical error |journal=BMJ |date=18 March 2000 |volume=320 |issue=7237 |pages=774–777 |doi=10.1136/bmj.320.7237.774 |pmid=10720365 |pmc=1117772 }}</ref> Poor communication (whether in one's own language or, as may be the case for [[medical tourism|medical tourists]], another language), improper documentation, illegible handwriting, spelling errors, inadequate nurse-to-patient ratios, and similarly named medications are also known to contribute to the problem.<ref>{{cite web |last1=Friedman |first1=Richard A. |last2=D |first2=M |year=2003 |url=https://www.nytimes.com/2003/03/11/health/cases-do-spelling-and-penmanship-count-in-medicine-you-bet.html |title=CASES; Do Spelling and Penmanship Count? In Medicine, You Bet |work=The New York Times |access-date=2018-08-29 |archive-date=August 29, 2019 |archive-url=https://web.archive.org/web/20190829071131/https://www.nytimes.com/2003/03/11/health/cases-do-spelling-and-penmanship-count-in-medicine-you-bet.html |url-status=live }}</ref><ref>{{Cite journal|last=Hannawa|first=Annegret F|date=June 2018|title="SACCIA Safe Communication": Five core competencies for safe and high-quality care|url=http://journals.sagepub.com/doi/10.1177/2516043518774445|journal=Journal of Patient Safety and Risk Management|language=en|volume=23|issue=3|pages=99–107|doi=10.1177/2516043518774445|s2cid=169364817|issn=2516-0435|access-date=April 21, 2021|archive-date=April 23, 2021|archive-url=https://web.archive.org/web/20210423104013/https://journals.sagepub.com/doi/10.1177/2516043518774445|url-status=live|url-access=subscription}}</ref> Misdiagnosis may be associated with individual characteristics of the patient or due to the patient [[multimorbidity]].<ref>{{Cite journal|last1=Lyundup|first1=Alexey V.|last2=Balyasin|first2=Maxim V.|last3=Maksimova|first3=Nadezhda V.|last4=Kovina|first4=Marina V.|last5=Krasheninnikov|first5=Mikhail E.|last6=Dyuzheva|first6=Tatiana G.|last7=Yakovenko|first7=Sergey A.|last8=Appolonova|first8=Svetlana A.|last9=Schiöth|first9=Helgi B.|last10=Klabukov|first10=Ilya D.|date=2021-10-29|title=Misdiagnosis of diabetic foot ulcer in patients with undiagnosed skin malignancies|journal=International Wound Journal|volume=19 |issue=4 |pages=871–887 |doi=10.1111/iwj.13688|issn=1742-481X|pmid=34713964|pmc=9013580 |s2cid=240154096}}</ref><ref>{{Cite journal|last1=Aoki|first1=Takuya|last2=Watanuki|first2=Satoshi|date=2020-08-20|title=Multimorbidity and patient-reported diagnostic errors in the primary care setting: multicentre cross-sectional study in Japan|journal=BMJ Open|volume=10|issue=8|pages=e039040|doi=10.1136/bmjopen-2020-039040|issn=2044-6055|pmc=7440713|pmid=32819954}}</ref> Patient actions or inactions may also contribute significantly to medical errors.<ref name="degruyter.com"/><ref name="De Gruyter"/>

=== Healthcare complexity ===
Complicated technologies,<ref>{{cite journal |last1=Maskell |first1=Giles |title=Error in radiology—where are we now? |journal=The British Journal of Radiology |year=2019 |volume=92 |issue=1096 |pages=20180845 |doi=10.1259/bjr.20180845|pmid=30457880 |pmc=6540865 }}</ref><ref>{{cite journal |last1=McGurk |first1=S |last2=Brauer |first2=K |last3=Macfarlane |first3=TV |last4=Duncan |first4=KA |title=The effect of voice recognition software on comparative error rates in radiology reports |journal=Br J Radiol |year=2008|volume=81 |issue=970 |pages=767–70 |doi=10.1259/bjr/20698753 |pmid=18628322 }}</ref> powerful drugs, intensive care, rare and multiple diseases,<ref>{{cite journal|author1=Wadhwa, R. R.|author2=Park, D. Y.|author3=Natowicz, M. R.|title=The accuracy of computer-based diagnostic tools for the identification of concurrent genetic disorders|journal=American Journal of Medical Genetics Part A|volume=176|issue=12|pages=2704–2709|doi=10.1002/ajmg.a.40651|pmid=30475443|year=2018|s2cid=53758271}}</ref> and prolonged hospital stay can contribute to medical errors.<ref>{{cite journal | vauthors = Weingart SN | title = Epidemiology of medical error | journal = Western Journal of Medicine | date=June 2000 | volume = 172 | issue = 6 | pages = 390–3 | doi = 10.1136/ewjm.172.6.390 | pmid = 10854389| pmc = 1070928 }}</ref> In turn, medical errors from carelessness or improper use of medical devices often lead to severe injuries or death. Since 2015, 60 injuries and 23 deaths have been caused by misplaced [[feeding tube]]s while using the Cortrak2 EAS system. The [[Food and Drug Administration|FDA]] recalled [[Avanos Medical]]'s Cortrak system in 2022 due to its severity and the high toll associated with the medical error.<ref>{{cite web |title=Feeding Tube Placement Devices Recalled After 23 Patient Deaths |url=https://www.schmidtlaw.com/feeding-tube-placement-devices-recalled-after-23-patient-deaths/ |website=schmidtlaw.com |access-date=February 13, 2023 |archive-date=February 13, 2023 |archive-url=https://web.archive.org/web/20230213205711/https://www.schmidtlaw.com/feeding-tube-placement-devices-recalled-after-23-patient-deaths/ |url-status=live }}</ref>

Complexity makes diagnosis especially challenging.  There are less than 200 symptoms listed in Wikipedia,<ref>List of medical symptoms. 
https://en.wikipedia.org/wiki/List_of_medical_symptoms#Medical_signs_and_symptoms {{Webarchive|url=https://web.archive.org/web/20220126155958/https://en.wikipedia.org/wiki/List_of_medical_symptoms#Medical_signs_and_symptoms |date=January 26, 2022 }}</ref> but there are probably more than 10,000 known diseases.  The World Health Organization's system for the International Classification of Disease, 9th Edition from 1979 listed over 14,000 diagnosis codes.<ref name="k260">{{cite journal | last1=Utter | first1=Garth H. | last2=Atolagbe | first2=Oluseun O. | last3=Cooke | first3=David T. | title=The Use of the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedure Classification System in Clinical and Health Services Research: The Devil Is in the Details | journal=JAMA Surgery | volume=154 | issue=12 | date=2019-12-01 | issn=2168-6262 | pmid=31553423 | doi=10.1001/jamasurg.2019.2899 | pages=1089–1090}}</ref>  Textbooks of medicine often describe the most typical presentations of a disease, but in many conditions patients may have variable presentations instead of the classical signs and symptoms.  To add complexity, the signs and symptoms of a given condition change over time; in the early stages the signs and symptoms may be absent or minimal, and then these evolve as the condition progresses.  Diagnosis is often challenging in infants and children who can't clearly communicate their symptoms, and in the elderly, where signs and symptoms may be muted or absent.<ref name="k570">{{cite journal | last=Emmett | first=K. R. | title=Nonspecific and atypical presentation of disease in the older patient | journal=Geriatrics | volume=53 | issue=2 |year=1998 | issn=0016-867X | pmid=9484285 | pages=50–52, 58–60}}</ref>

There are more than 7000 rare diseases alone, and in aggregate these are not uncommon: Roughly 1 in 17 patients will be diagnosed with a rare disease over their lifetime.<ref name="u708">{{cite journal | last1=Ronicke | first1=Simon | last2=Hirsch | first2=Martin C. | last3=Türk | first3=Ewelina | last4=Larionov | first4=Katharina | last5=Tientcheu | first5=Daphne | last6=Wagner | first6=Annette D. | title=Can a decision support system accelerate rare disease diagnosis? Evaluating the potential impact of Ada DX in a retrospective study | journal=Orphanet Journal of Rare Diseases | volume=14 | issue=1 | date=2019-03-21 | issn=1750-1172 | pmid=30898118 | pmc=6427854 | doi=10.1186/s13023-019-1040-6 | doi-access=free | page=69}}</ref>  Physicians may have only learned a handful of these during their education and training.

=== System and process design ===
In 2000, The Institute of Medicine released "[[To Err Is Human (report)|To Err is Human]]," which asserted that the problem in medical errors is not bad people in health care—it is that good people are working in bad systems that need to be made safer.<ref name=toerr />

Poor communication and unclear lines of authority of physicians, nurses, and other care providers are also contributing factors.<ref name=cause /> Disconnected reporting systems within a hospital can result in fragmented systems in which numerous hand-offs of patients results in lack of coordination and errors.<ref name=Gardner>{{cite news |last=Gardner |first=Amanda |date=6 March 2007 |url=https://www.washingtonpost.com/wp-dyn/content/article/2007/03/06/AR2007030601334.html |title=Medication Errors During Surgeries Particularly Dangerous |newspaper=The Washington Post |access-date=2007-03-13 |archive-date=July 15, 2018 |archive-url=https://web.archive.org/web/20180715075937/http://www.washingtonpost.com/wp-dyn/content/article/2007/03/06/AR2007030601334.html |url-status=live }}</ref>

Other factors include the impression that action is being taken by other groups within the institution, reliance on automated systems to prevent error.,<ref name=barcode>{{cite journal |last=McDonald, MD |first=Clement J. |title=Computerization Can Create Safety Hazards: A Bar-Coding Near Miss |journal=Annals of Internal Medicine |volume=144 |issue=7 |pages=510–516 |date=4 April 2006 |pmid=16585665 |doi=10.7326/0003-4819-144-7-200604040-00010|doi-access=free }}</ref> and inadequate systems to share information about errors, which hampers analysis of contributory causes and improvement strategies.<ref>{{cite web |last=US Agency for Healthcare Research & Quality |date=2008-01-09 |url=http://www.ahrq.gov/news/press/pr2008/errepsyspr.htm |title=Physicians Want To Learn from Medical Mistakes but Say Current Error-reporting Systems Are Inadequate |access-date=2008-03-23 |url-status=dead |archive-url=https://web.archive.org/web/20080217054943/http://www.ahrq.gov/news/press/pr2008/errepsyspr.htm |archive-date=2008-02-17 }}</ref>
Cost-cutting measures by hospitals in response to reimbursement cutbacks can compromise [[patient safety]].<ref>{{cite journal |author1=Clement JP |author2=Lindrooth RC |author3=Chukmaitov AS |author4=Chen HF |title=Does the patient's payer matter in hospital patient safety?: a study of urban hospitals |journal=Med Care |volume=45 |issue=2 |pages=131–8 |date=February 2007 |pmid=17224775 |doi=10.1097/01.mlr.0000244636.54588.2b|s2cid=22206854 }}</ref>
In emergencies, patient care may be rendered in areas poorly suited for safe monitoring. The American Institute of Architects has identified concerns for the safe design and construction of health care facilities.<ref>{{cite journal |journal=The American Institute of Architects Academy Journal |title=Incorporating Patient-Safe Design into the Guidelines |date=2005-10-19 |url=http://www.aia.org/journal_aah.cfm?pagename=aah_jrnl_20051019_guidelines&dspl=1&article=article |access-date=August 11, 2010 |archive-date=October 7, 2006 |archive-url=https://web.archive.org/web/20061007082132/http://www.aia.org/journal_aah.cfm?pagename=aah_jrnl_20051019_guidelines |url-status=dead }}</ref>
Infrastructure failure is also a concern. According to the [[WHO]], 50% of medical equipment in developing countries is only partly usable due to lack of skilled operators or parts. As a result, diagnostic procedures or treatments cannot be performed, leading to substandard treatment.

The [[JCAHO|Joint Commission]]'s Annual Report on Quality and Safety 2007 found that inadequate communication between healthcare providers, or between providers and the patient and family members, was the [[root cause analysis|root cause]] of over half the serious adverse events in accredited hospitals.<ref>{{Cite web |url=http://www.jointcommissionreport.org/ |title=Improving America's Hospitals |access-date=August 11, 2010 |archive-date=April 16, 2008 |archive-url=https://web.archive.org/web/20080416205706/http://www.jointcommissionreport.org/ |url-status=live }}</ref> Other leading causes included inadequate assessment of the patient's condition, and poor leadership or training.

=== Competency, education, and training ===
Variations in healthcare provider training & experience<ref name=cause>{{cite journal |last1=Neale |first1=Graham |last2=Woloshynowych |first2=Maria |last3=Vincent |first3=Charles |title=Exploring the causes of adverse events in NHS hospital practice |journal=Journal of the Royal Society of Medicine |volume=94 |issue=7 |pages=322–30 |date=July 2001 |pmc=1281594 |pmid=11418700|doi=10.1177/014107680109400702 }}</ref><ref name="pmid2013929" /> and failure to acknowledge the prevalence and seriousness of medical errors also increase the risk.<ref>{{cite journal |author=Michael L. Millenson |year=2003 |title=The Silence |journal=Health Affairs |volume=22 |pages=103–112 |doi=10.1377/hlthaff.22.2.103 |pmid=12674412 |issue=2|s2cid=40037135 }}</ref><ref>{{cite journal |last=Henneman |first=Elizabeth A. |date=1 October 2007 |title=Unreported Errors in the Intensive Care Unit, A Case Study of the Way We Work |journal=Critical Care Nurse |volume=27 |pages=27–34 |url=http://ccn.aacnjournals.org/cgi/content/full/27/5/27 |access-date=2008-03-23 |pmid=17901458 |issue=5 |doi=10.4037/ccn2007.27.5.27 |archive-date=October 13, 2008 |archive-url=https://web.archive.org/web/20081013050913/http://ccn.aacnjournals.org/cgi/content/full/27/5/27 |url-status=live |url-access=subscription }}</ref> The so-called [[July effect]] occurs when new residents arrive at teaching hospitals, causing an increase in medication errors according to a study of data from 1979 to 2006.<ref name="Phillips & Barker">{{cite journal |author1=Phillips DP |author2=Barker GE |title=A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents |journal=J Gen Intern Med |volume=25 |issue=8 |pages=774–779|date=May 2010 |pmid=20512532 |doi=10.1007/s11606-010-1356-3 |pmc=2896592}}</ref><ref name=amednews1>{{cite journal |last1=Krupa |first1=Carolyne |title=New residents linked to July medication errors |journal=American Medical News |date=21 June 2010 |volume=6 |issue=21 |url=https://insights.ovid.com/american-medical-news/ammn/2010/06/210/new-residents-linked-july-medication-errors/14/00000476 |access-date=September 8, 2019 |archive-date=October 21, 2020 |archive-url=https://web.archive.org/web/20201021103522/https://insights.ovid.com/american-medical-news/ammn/2010/06/210/new-residents-linked-july-medication-errors/14/00000476 |url-status=live }}</ref>

=== Human factors and ergonomics ===
[[File:Okunuşu,yazılışı yakın ilaçlar.jpg|thumb|250px|A plate written in a hospital, containing drugs that are similar in spelling or writing]]
[[Human error|Cognitive errors]] commonly encountered in medicine were initially identified by psychologists [[Amos Tversky]] and [[Daniel Kahneman]] in the early 1970s. [[Jerome Groopman]], author of ''[[How Doctors Think]]'', says these are "cognitive pitfalls", biases which cloud our logic. For example, a practitioner may overvalue the first data encountered, skewing their thinking. Another example may be where the practitioner recalls a recent or dramatic case that quickly comes to mind, coloring the practitioner's judgement. Another pitfall is where [[stereotypes]] may prejudice thinking.<ref>{{cite magazine |url=http://www.nybooks.com/articles/archives/2009/nov/05/diagnosis-what-doctors-are-missing/ |title=Diagnosis: What Doctors are Missing |author=Jerome E. Groopman |date=5 November 2009 |magazine=[[New York Review of Books]] |author-link=Jerome E. Groopman |access-date=July 9, 2014 |archive-date=September 17, 2015 |archive-url=https://web.archive.org/web/20150917174143/http://www.nybooks.com/articles/archives/2009/nov/05/diagnosis-what-doctors-are-missing/ |url-status=live }}</ref>  Pat Croskerry describes clinical reasoning as an interplay between intuitive, subconscious thought (System 1) and deliberate, conscious rational consideration (System 2).  In this framework, many cognitive errors reflect over-reliance on System 1 processing, although cognitive errors may also sometimes involve System 2.<ref>{{cite journal |last1=Croskerry |first1=P. |year=2009 |title=A Universal Model of Clinical Reasoning |journal=Acad Med |volume=84 |issue=8 |pages=1022–8 |doi=10.1097/ACM.0b013e3181ace703 |pmid=19638766 |doi-access=free}}</ref>

[[Sleep deprivation]] has also been cited as a contributing factor in medical errors.<ref name=":0">{{cite journal |last1=Ker |first1=Katharine |last2=Edwards |first2=Philip James |last3=Felix |first3=Lambert M |last4=Blackhall |first4=Karen |last5=Roberts |first5=Ian |date=12 May 2010 |title=Caffeine for the prevention of injuries and errors in shift workers |journal=Cochrane Database of Systematic Reviews |volume=2010 |issue=5 |pages=CD008508 |doi=10.1002/14651858.CD008508 |pmc=4160007 |pmid=20464765}}</ref> One study found that being awake for over 24 hours caused [[medical interns]] to double or triple the number of preventable medical errors, including those that resulted in injury or death.<ref>{{cite journal |last1=Barger |first1=L. K. |last2=Ayas |first2=N. T. |last3=Cade |first3=B. E. |last4=Cronin |first4=J. W. |last5=Rosner |first5=B. |last6=Speizer |first6=F. E. |last7=Czeisler |first7=C. A. |display-authors=1 |year=2006 |title=Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attentional Failures |journal=PLOS Med |volume=3 |issue=12 |page=e487 |doi=10.1371/journal.pmed.0030487 |pmc=1705824 |pmid=17194188 |doi-access=free }}</ref> The risk of car crash after these shifts increased by 168%, and the risk of [[Near miss (safety)|near miss]] by 460%.<ref name="npr">{{Cite web |url=https://www.npr.org/templates/story/story.php?storyId=6619687 |title=When Doctors Don't Sleep |website=[[NPR]] |access-date=April 3, 2018 |archive-date=May 9, 2021 |archive-url=https://web.archive.org/web/20210509151219/https://www.npr.org/templates/story/story.php?storyId=6619687 |url-status=live }}</ref> Interns admitted falling asleep during lectures, during rounds, and even during surgeries.<ref name="npr" /> Night shifts are associated with worse surgeon performance during laparoscopic surgeries.<ref name=":0" />

Practitioner risk factors include fatigue,<ref>{{cite journal |last1=Nocera |first1=Antony |last2=Khursandi |first2=Diana Strange |title=Doctors' working hours: can the medical profession afford to let the courts decide what is reasonable? |journal=Medical Journal of Australia |date=June 1998 |volume=168 |issue=12 |pages=616–618 |doi=10.5694/j.1326-5377.1998.tb141450.x |pmid=9673625 |s2cid=34759813 }}</ref><ref name="pmid15509817">{{cite journal |last1=Landrigan |first1=Christopher P. |last2=Rothschild |first2=Jeffrey M. |last3=Cronin |first3=John W. |last4=Kaushal |first4=Rainu |last5=Burdick |first5=Elisabeth |last6=Katz |first6=Joel T. |last7=Lilly |first7=Craig M. |last8=Stone |first8=Peter H. |last9=Lockley |first9=Steven W. |last10=Bates |first10=David W. |last11=Czeisler |first11=Charles A. |title=Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units |journal=New England Journal of Medicine |date=28 October 2004 |volume=351 |issue=18 |pages=1838–1848 |doi=10.1056/NEJMoa041406 |pmid=15509817 |doi-access=free }}</ref><ref>{{cite journal |last1=Barger |first1=Laura K |last2=Ayas |first2=Najib T |last3=Cade |first3=Brian E |last4=Cronin |first4=John W |last5=Rosner |first5=Bernard |last6=Speizer |first6=Frank E |last7=Czeisler |first7=Charles A |last8=Mignot |first8=Emmanuel |title=Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attentional Failures |journal=PLOS Medicine |date=12 December 2006 |volume=3 |issue=12 |pages=e487 |doi=10.1371/journal.pmed.0030487 |pmid=17194188 |pmc=1705824 |doi-access=free }}</ref>
depression,<ref name="Association Between Physician Depre">{{cite journal |last1=Pereira-Lima |first1=K |last2=Mata |first2=DA |last3=Loureiro |first3=SR |last4=Crippa |first4=JA |last5=Bolsoni |first5=LM |last6=Sen |first6=S |year=2019 |title=Association Between Physician Depressive Symptoms and Medical Errors: A Systematic Review and Meta-analysis |journal=JAMA Network Open |volume=2 |issue=11 |pages=e1916097 |doi=10.1001/jamanetworkopen.2019.16097 |pmid=31774520 |pmc=6902829 }}</ref> and burnout.<ref>{{cite journal |last1=Fahrenkopf |first1=Amy M |last2=Sectish |first2=Theodore C |last3=Barger |first3=Laura K |last4=Sharek |first4=Paul J |last5=Lewin |first5=Daniel |last6=Chiang |first6=Vincent W |last7=Edwards |first7=Sarah |last8=Wiedermann |first8=Bernhard L |last9=Landrigan |first9=Christopher P |title=Rates of medication errors among depressed and burnt out residents: prospective cohort study |journal=BMJ |date=1 March 2008 |volume=336 |issue=7642 |pages=488–491 |doi=10.1136/bmj.39469.763218.BE |pmid=18258931 |pmc=2258399 }}</ref>
Factors related to the clinical setting include diverse patients, unfamiliar settings, time pressures, and increased patient-to-nurse staffing ratio increases.<ref>{{cite journal |last1=Aiken |first1=Linda H. |last2=Clarke |first2=SP |last3=Sloane |first3=DM |last4=Sochalski |first4=J |last5=Silber |first5=JH |title=Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction |journal=JAMA |date=23 October 2002 |volume=288 |issue=16 |pages=1987–93 |doi=10.1001/jama.288.16.1987 |pmid=12387650 |doi-access=free }}</ref>
Drug names that look alike or sound alike are also a problem.<ref>{{cite web | last=8th Annual MEDMARX Report | date=2008-01-29 | url=http://www.usp.org/aboutUSP/media/newsCenter.html?article=105435 | title=Press Release | publisher=U.S. Pharmacopeia | access-date=2008-03-23 | url-status=dead | archive-url=https://archive.today/20080208093723/http://www.usp.org/aboutUSP/media/newsCenter.html?article=105435 | archive-date=2008-02-08 }}</ref>

Errors in interpreting medical images are often perceptual instead of "fact-based"; these errors are often caused by failures of attention or vision.<ref name="Analysis of Perceptual Expertise in">{{cite journal |last1=Waite |first1=Stephen |last2=Grigorian |first2=Arkadij |last3=Alexander |first3=Robert G. |last4=Macknik |first4=Stephen L. |last5=Carrasco |first5=Marisa |last6=Heeger |first6=David J. |last7=Martinez-Conde |first7=Susana |title=Analysis of Perceptual Expertise in Radiology – Current Knowledge and a New Perspective |journal=Frontiers in Human Neuroscience |date=25 June 2019 |volume=13 |pages=213 |doi=10.3389/fnhum.2019.00213 |pmid=31293407 |pmc=6603246 |doi-access=free }}</ref> For example, visual illusions can cause radiologists to misperceive images.<ref>{{cite journal |last1=Alexander |first1=Robert |last2=Yazdanie |first2=Fahd |last3=Waite |first3=Stephen Anthony |last4=Chaudhry |first4=Zeshan |last5=Kolla |first5=Srinivas |last6=Macknik |first6=Stephen |last7=Martinez-Conde |first7=Susana |title=Visual Illusions in Radiology: untrue perceptions in medical images and their implications for diagnostic accuracy |journal=Frontiers in Neuroscience |year=2021 |volume=15 |page=629469 |doi=10.3389/fnins.2021.629469|pmid=34177444 |pmc=8226024 |doi-access=free }}</ref>

A number of Information Technology (IT) systems have been developed to detect and prevent medication errors, the most common type of medical errors.<ref>{{Cite book|last=Anderson|first=J.G.|title=Information technology for detecting medication errors and adverse drug events. (Expert Opin Drug Saf 3)|year=2005|pages=449–455}}</ref> These systems screen data such as ICD-9 codes, pharmacy and laboratory data. Rules are used to look for changes in medication orders, and abnormal laboratory results that may be indicative of medication errors and/or adverse drug events.<ref>{{Cite journal|last1=Abrahamson|first1=Kathleen|last2=Anderson|first2=J.G.|year=2017|title=Your Health Care May Kill You: Medical Errors|journal=Studies in Health Technology and Informatics|volume=234|issue=Building Capacity for Health Informatics in the Future|pages=13–17|doi=10.3233/978-1-61499-742-9-13|pmid=28186008|url=https://ebooks.iospress.nl/publication/46132|access-date=September 2, 2021|archive-date=September 2, 2021|archive-url=https://web.archive.org/web/20210902215631/https://ebooks.iospress.nl/publication/46132|url-status=live|url-access=subscription}}</ref>