Doctors make mistakes. The best medicine is for them to admit it

In “Why doctors fail”, the first of his Reith Lectures, Atul Gawande – the American surgeon and celebrated author – describes movingly how his son, Walker, was rushed to hospital with a heart defect 11 days after he was born, and almost died as a result of a grievous error by medical staff. They attached a monitor to his finger to check the oxygen level in his blood which showed 98% saturation – a normal healthy reading. What they had not realised was that Walker had a problem with his aorta – the main artery – which was supplying blood only to one side of his body.

A paediatrician was called who ordered staff to switch the monitor to a finger of the other hand. Now they found the oxygen level to be so low it was unreadable – and Walker was already going into kidney failure. He was given an emergency injection to open up his circulation and spent several days in intensive care before he was well enough to have surgery to correct the defect.

That swift action in 1995 saved him. This summer Walker left school and started college. “He is going to live a long and normal life. It’s amazing,” said Gawande. Yet in the very next cot to Walker’s lay a child with the same condition for whom help had come too late. He had gone into organ failure, was awaiting a transplant, and faced “a very different future”.

Gawande’s theme in yesterday’s lecture, as in much of his writing, is how to overcome failure – how to ensure the monitor is on the correct finger. His answer is to appeal for transparency. “How are we going to make it possible for other children like Walker to live a normal life? Only by removing the veil over what happens in the clinic and hospital, only by making what has been invisible visible.”

Yet efforts at transparency have frequently been hindered – out of fear that the information will be distorted, or that people will jump to the wrong conclusions. “The data, when we have it, is often blocked. We don’t know which hospitals have better complication rates because of fears about misuse and injustice. But there are lives at stake,” he says.

Here in the UK we have faced similar challenges. Last week the NHS marked a milestone with the publication ofindividual death rates for 5,000 surgeons in 10 major specialisms, in the latest step towards a more transparent health service. But it has taken more than a decade of tough negotiations by Bruce Keogh, the NHS medical director for England, who launched a crusade for greater openness in the late 1990s – beginning with heart surgeons, of which he was one.

Meanwhile Colchester general hospital declared a major internal incident last week and closed its A&E department to all but serious and life-threatening injuries after a surprise inspection by the Care Quality Commission. The hospitaladmitted it had suffered 563 serious incidents over two years – details that are rarely made public.

We know that thousands of NHS patients die or suffer serious injuries or infections each year as a result of medical errors. Recent research shows that in the US, one in every three dollars spent on healthcare arises from the costs of errors. There have been gains – improved infection control in the NHS has led to a 90% fall in cases of MRSA. But the persistent failure to use and learn from mistakes is a huge missed opportunity. Around 1.2m incidents are being reported in the NHS each year, and at the Institute of Global Health Innovation at Imperial College London, which I lead, we are researching better ways of collecting and disseminating the data.

One of the barriers we face is the popular view that saving lives demands heroism. This is a notion given currency night after night in fictional accounts of what we do. The idea propagated by series such as House – showcasing the heroic doctor as mercurial medical detective – is that disaster is averted by acts of impromptu brilliance performed by radicals who have little regard for conventional practice.

In fact, more lives are actually saved when doctors adopt a step-by-step systematic approach based on the evidence of what works. It is less glamorous and involves hard, unremitting effort. But – as a report led by Professor Peter Pronovost, an internationally renowned expert on patient safety at Johns Hopkins Hospital in Maryland, will say when it is presented to the World Innovation Summit on Health in February – this is the only sure way towards safer care.

Looking at our fallibility is uncomfortable, it makes people angry and has led to efforts at providing transparency being blocked. But as Gawande says, it is the story of our time – and the key to the future of medicine.