Doctors are more dangerous than gun owners: a rejoinder to error counting.

OBJECTIVE: This paper analyzes some of the problems with error counting as well as the difficulty of proposing viable alternatives.
BACKGROUND: Counting and tabulating negatives (e.g., errors) are currently popular ways to measure and help improve safety in a variety of domains. They uphold an illusion of rationality and control but may offer neither real insight nor productive routes for improving safety.
METHOD: The paper conducts a critical analysis of assumptions underlying error counting in human factors.
RESULTS: Error counting is a form of structural analysis that focuses on (supposed) causes and consequences; it defines risk and safety instrumentally in terms of minimizing negatives and their measurable effects. In this way, physicians can be proven to be 7500 times less safe than gun owners, as they are responsible for many more accidental deaths.
CONCLUSION: The appeal of error counting may lie in a naive realism that can enchant researchers and practitioners alike. Supporting facts will continue to be found by those looking for errors through increasingly refined methods. APPLICATION: The paper outlines a different approach to understanding safety in complex systems that is more socially and politically oriented and that places emphasis on interpretation and social construction rather than on putatively objective structural features.