My journey to a career focus of medical error was influenced by two factors: Gestalt psychology and interrupted graduate study. My undergraduate work with Gestaltist Al Pepitone at the University of Pennsylvania was furthered at the University of Kansas (KU) where I had the privilege of studying with Martin Scheerer, Herb Wright, Fritz Heider, and vicariously through them with Kurt Lewin. I learned to appreciate beliefs, values, attitudes, and behavior from the perspective of the individual, the perceiver. I learned that what is aberrant to an observer is reasonable to the individual's critical lesson for the study of error.

Equipped with a BS in psychology and mathematics, I moved 40 miles from KU, worked as a consulting actuary, performed household and social obligations, and had a child as was de rigueur at that time. My determination to ultimately obtain a PhD intensified when, contrary to then societal expectations, I found no satisfaction from a clean bathroom floor. I returned to KU for an MA, taking particular delight and insight from Grace Heider's History and Systems course. Another educational hiatus occurred for a second child. My desire for a PhD was unabated by a life of golf, tennis, and shopping. I resumed the bifurcated existence of an upstanding small town citizen with family, social, and community responsibilities and an enthusiastic Gestalt psychology student with an 80-mile commute. That bifurcation provided the "ground" of real world life to use a Gestalt analogy, for the "figure" of psychology--a perspective that has served me well.

I moved to Washington with my PhD, two children, five dogs, four cats, and assorted rodents, to begin my professional life teaching at Catholic University. My courses were popular, particularly with nurses who sought insight for their concerns such as convincing physicians trained to cure people that their dying patients needed them. I continued applying psychology to medicine at the National Academy of Science-an Institute of Medicine where I analyzed the effectiveness of efforts to change physician behavior that did not meet the standards of quality assurance. After that, I worked for the Health Services Administration where I monitored research on a range of issues from Haitian immigration to health and social services for elderly Chinese in San Francisco. When Reagan took office, my position was among those abolished.

I became a research psychologist for the Army Research Institute where I monitored the redesign of the self-propelled howitzer turret in order to minimize operator error. This opportunity enabled me to consolidate my previous experience, my Gestalt education, and my penchant for applying that education. A contractor, Fred Muckler, who worked with me on the turret, also consulted for the Food and Drug Administration (FDA). He told FDA that my experience with error issues would be applicable to their endeavors; they offered me a position.

At FDA I analyzed reports that attributed death or serious injury involving medical devices to user error. I determined if any aspect of the device within FDA's purview (design, labeling, or packaging) had a role in the event from the perspective of the user. I found almost without exception that the design of the device contributed to error. Because medical care affects everyone, I felt medical error was a topic relevant to the broad professional community. I organized a full day session on Medical Error at the 1991 American Association for the Advancement of Science annual meeting-one of the first public statements of the problem. I have continued organizing sessions and speaking on variations of that topic at meetings of the Human Factors and Ergonomics Society and other professional groups. In 1994 my edited book, Human Error in Medicine, written with personal time and money, was published to very positive reviews. From that came requests for talks, book chapters, and articles-all done on non-FDA time. It became impossible to meet those demands, even with 3-and-a-half hours of sleep. I had to decide: work on human error in medicine or work at the FDA. I am now an independent consultant on medical error.

Every aspect of psychology is relevant to some aspect of medical error. Examples of actual situations, such as inappropriate procedures performed through misunderstandings among operating room personnel and confusion using technologically sophisticated medical devices, are replete with social and cognitive issues when the perspective of the user is considered. As a consultant I can apply my knowledge of psychology to promote the approach that medical error is the result of contributing factors in the context of care, to identify those factors, and to advise modifications to reduce the likelihood of error. Venues for my work include hospitals, nursing homes, home health situations, medical device manufacturers, professional organizations, medical schools, and the courtroom.

Medical error and medical care represent a new frontier for psychology-one to which our discipline, through the strength of its diversity, can contribute significantly. The time to do so is now-the Zeitgeist is right for psychology to demonstrate its strength and relevance for enhancing people's physical as well as mental health. •

 
(Originally published in the May/June 1999 issue of Psychological Science Agenda, the newsletter of the APA Science Directorate.)
 

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