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Room for Improvement: Patients Report on the Quality of Their Health Care

More than one of five Americans report that they or a family member had experienced a medical or prescription drug error, according to this study by The Commonwealth Fund. The report, Room for Improvement: Patients Report on the Quality of Their Health Care, by Karen Davis, Stephen C. Schoenbaum, Karen Scott Collins, Katie Tenney, Dora L. Hughes, and Anne-Marie J. Audet, is based on The Commonwealth Fund 2001 Health Care Quality Survey, which consisted of interviews with 6,722 adults conducted by Princeton Survey Research Associates.

A review of respondents' evaluations of these errors shows that one of ten adults reported they or a family member had gotten sicker as a result of a mistake in a doctor's office or the hospital, and about half of those said the problem was very serious. Of the 16 percent reporting a medication error, more than one-fifth said the error turned out to be very serious. Nationally, this translates into an estimated 22.8 million people reporting at least one family member who experienced a mistake, and 8.1 million households reporting at least one family member who had a serious problem.

The report also reveals missed opportunities regarding health care, from a failure to get preventive services to substandard care for chronic conditions, which can lead to needless suffering, a poorer quality of life, and greater long-term health care costs. Regarding patient-physician interaction, the study estimates that nearly one-fourth (24%) of Americans who saw a doctor in the past two years did not follow the doctor's advice, often because they disagreed with it.

The report documents serious underuse of preventive services and inadequate monitoring of chronic conditions. For example, one-fifth of women over 18 had not undergone a Pap test in a three-year interval, one-fifth of adults had not had a cholesterol screening exam in the past five years, and 44 percent of adults did not have an annual dental exam. Also, 45 percent of adult diabetics reported that they had not received three recommended annual check-ups (eye exam, foot exam, and blood pressure test).

Of the 24 percent of survey respondents who had a health care visit in the past two years and said there had been a time when they did not follow physicians' advice, two of five (39%) said the reason was they disagreed with the doctor, another 27 percent said following the advice would be too costly, 26 percent said it would be too difficult, and 20 percent said it was against their personal beliefs.

Facts and Figures

  • Almost half of survey respondents reported a serious health problem—high blood pressure, heart attack, cancer, diabetes, anxiety or depression, obesity, or asthma—diagnosed by a physician in the past five years.
  • One-third (34%) of adults in the survey had the same physician for more than five years.
  • Almost three of ten (29%) survey respondents without a high school education reported having a communication problem with their doctor, compared with one of six (17%) college graduates.

Publication Details



K. Davis, S. C. Schoenbaum, K. S. Collins, K. Tenney, D. L. Hughes, and A.-M. J. Audet, Room for Improvement: Patients Report on the Quality of Their Health Care, The Commonwealth Fund, April 2002.