Patients contribute to errors.

As an endocrinologist, I deeply admire the gumption of internists who soldier on despite all the cards stacked against them in the current medical practice world. As such I was both disturbed and distressed by Dr. Paul Sovran's letter ("'Study' on Errors Has Its Own Flaws," Letters, Oct. 1, 2007, p. 10). He challenged the validity of a study about diagnostic errors committed by internists. In response, Dr. Mark Graber said that we should not be complacent about the current error rates of internists.

What about the patients' role in this problem? The assumption that an error-free medical utopia is attainable just by addressing the deficits of hospitals and doctors leaves the human frailties of our patients out of the equation.

Many patients are self-saboteurs and wind up costing the system a lot--those who do not listen, who do not care to know the names or dosages of their medications, who do not bring with them previous blood test reports or information from other doctors they have seen, who do not follow through on blood tests ordered, who are not available for discussion of results, who refuse to budge from illconceived notions about their symptoms, who muddy the waters of their medical histories with exaggerations and histrionics, who say little and expect the doctors to dig out information, who engage in power struggles with their doctors just for the sheer fun of it--I could go on and on.

Medicine is a dynamic field where what is right and accepted one day is proved to be dangerous and unacceptable not long thereafter. It is through our mistakes that we learn, change, and grow. The once-collaborative and congenial atmosphere in medicine--where subspecialists and internists taught each other to enhance patient care--has been destroyed by the current business model. The two groups of doctors pitted against each other are bruised and battered and have no other resort but to vent like Dr. Sovran.

Usha Srinivasan, M.D.

Bel Air, Md.