Of the public and physicians reporting that they or their family members have experienced medical errors in the course of receiving medical care, a significant percentage said the blunders resulted in serious consequences, according to the survey.

However, implementing actions recommended by experts on medical errors may not be easy. Despite widespread personal experience, neither the public nor physicians name medical errors as a top problem facing healthcare and medicine today, the researchers reported.

Physicians and the public also disagree about many proposed solution, the survey found.

Findings from the survey by Harvard and Kaiser researchers were discussed in a New England Journal of Medicine article published yesterday. The nationwide survey examined the views of 831 physicians in April-July 2002 and 1,207 adults in April-June 2002.

"One of the striking findings of this study is that physicians disagree with national experts on the effectiveness of many of the proposed solutions to the problem of medical errors," said Robert Blendon, professor of health policy at the Harvard School of Public Health in Cambridge, Mass.

"This survey provides strong documentation that medical errors represent a problem that affects a significant number of people," said Drew Altman, president and chief executive officer of the Kaiser Family Foundation in Menlo Park, Calif.

"The fact that so many physicians report personal experiences with errors corroborates what we heard from the public," Mr. Altman added.

In the survey, both physicians and the public were read a common definition of a medical error early on.

? 35 percent of physicians and 42 percent of the public reported experiencing a medical error in their own care or that of a family member at some point in their life.

? 18 percent of physicians and 24 percent of the public said an error caused "serious health consequences" such as death (reported by 7 percent of physicians and 10 percent of the public), long-term disability (6 percent and 11 percent, respectively) or severe pain (11 percent and 16 percent, respectively).

? Nearly three in 10 (29 percent) of all doctors said that in their role as a physician they had seen a medical error that resulted in serious harm to a patient in the last year, and a majority of those who saw an error said it is "very likely" (15 percent) or "somewhat likely" (45 percent) that they would see a similar one at the same institution in the next year.

Doctors and the public agree that as many as half of the deaths due to medical errors could have been prevented, but neither group listed medical errors among the top "problems facing healthcare and medicine in the country today." Only 5 percent of physicians and 6 percent of the public identified medical errors as a top concern.

Instead, when asked to name in an open-ended question the top problems facing healthcare and medicine today, physicians identified malpractice insurance costs and lawsuits (29 percent), healthcare costs (27 percent), and problems with insurance companies and health plans (22 percent).

The public cited healthcare cost (38 percent) and cost of prescription drugs (31 percent) as the top problems facing healthcare and medicine.

Doctors and the public differ in their views of the most effective ways of reducing medical errors. Much of the public agreed that nine of the 16 offered proposals could be very effective, but a majority of practicing physicians saw just two proposals as very effective--requiring hospitals to develop systems to avoid medical errors (55 percent) and increasing the number of hospital nurses (51 percent).

Physicians and the public disagree substantially in their views on some of the key proposals:

? Seven in 10 of the public (71 percent) said requiring hospitals to report errors to a state agency would be very effective, compared with 23 percent of physicians.

? A majority of the public (62 percent) said reports of serious errors should be released publicly; just 14 percent of physicians agreed, with most doctors (86 percent) saying hospital reports should remain confidential.

? Half of the public (50 percent), but only 3 percent of physicians, said that suspending the licenses of health professionals who make medical errors would be a very effective solution for reducing errors.

? Two-thirds of the public said it would be very effective to reduce the work hours of physicians in training (66 percent) compared to 33 percent of physicians.

Physicians and the public do not necessarily agree with the views of experts regarding the effectiveness of certain approaches to reducing errors. For example, less than a majority of both physicians and the public believes that limiting certain high-risk procedures to high-volume centers (40 percent of physicians, 45 percent of public), increasing use of computerized medical records (19 percent and 46 percent, respectively), or use of computers in ordering of medical tests and drugs (23 percent and 45 percent, respectively) would be very effective solutions.

Furthermore, about one-third of physicians (34 percent) agreed in the survey that another key proposal of experts--using only physicians trained in intensive care medicine in hospital ICUs--would be very effective.

Physicians said the leading causes of errors are a shortage of nurses (53 percent) and overwork, stress or fatigue of health professionals (50 percent). A majority of the public identified seven causes--the top four they cited are physicians not having enough time with patients (72 percent); overwork, stress or fatigue of health professionals (70 percent), health professionals not working together or communicating as a team (67 percent) and a shortage of nurses (65 percent).

About seven in 10 physicians thought an error would be more likely at a hospital that does fewer procedures. The public was less sure, with about half saying that an error would be more likely at a low-volume center and the other half saying that errors would be more likely at a high-volume center (23 percent) or that volume would make no difference (26 percent).

The survey by Harris Interactive Inc. contacted 831 physicians by mail or online and reached 1,207 adults in the general public by telephone. The error margin for doctors was put at plus or minus 3.5 percent and for the public plus or minus 2.6 percent.

More detail on the survey is available at www.hsph.harvard.edu.