You're a firefighter. You arrive at a burning house and hear screaming. There are 10 people inside. You run in and save 9 lives, but despite your best efforts, one person perishes. So, should you be cited for heroism-or indicted for homicide'?
Reading Pap smears is a difficult and complex human endeavor in which mistakes are inevitable, and therefore, normal. In fact, not only are mistakes normal, they may even be necessary for the success of this screening test. The time and money that would be required to perfect the Pap smear would make it exorbitantly expensive-few could afford it and its value as a screening test would therefore be greatly diminished. Another price to be paid for trying to perfect the Pap smear is that with increased sensitivity comes decreased specificity. To carry this statistical concept to its absurd conclusion, we could achieve 100% sensitivity simply by diagnosing every single case as "abnormal." But, if every result were "positive," this obviously would completely destroy the Pap smear's usefulness as a screening test. Unfortunately, when the personal cost of our inevitable diagnostic mistakes may be measured in millions of dollars in malpractice awards, loss of one's professional reputation, and possibly even criminal prosecution, there is already tremendous pressure to diagnose even the most minimal atypia as "abnormal." This is only reinforced by the willingness of "experts" to testify that the standard of care was breached by failure to diagnose such irreproducible results as ASCUS (Atypical Squamous Cells of Undetermined Significance).
Unfortunately, in the current malpractice climate, mistakes pose severe risk management and liability problems, making the slides in our files like time bombs, just waiting to explode in our faces. Wouldn't it be better to acknowledge that in medicine, like in anything else, people make m i s - takes? Mistakes could be viewed as important opportunities