Background: The complexity of decision-making and diversity of tasks in pediatric practice can lead to medical errors. To confirm the hypothesis that physicians’ emotions influence the occurrence of medical errors, we
analyzed medical adverse event reports to assess the effect of emotional factors on pediatrician decision-making
and medical errors.
Methods: This study involved case analyses of reports of pediatrician-related medical adverse events drawn
from a Japanese national medical database. We examined 310 adverse medical event reports involving pediatrician errors recorded over a 6-year period. Reports involving decision-making errors were extracted and analyzed
by the patient’s age, doctor’s experience, severity of the adverse event, event circumstances, timing of errors by
decision-making stage, and the presence of emotional factors.
Results: We found decision-making errors in 58.6% of the examined medical adverse events reports. Most
errors occurred in the situation awareness and decision stages. Overall, 53.2% of cases involving decision-making
errors showed emotional involvement in the adverse event occurrence. The three emotional factors that most
affected errors were trust, optimism, and distraction.
Conclusions: Over half of the cases of errors in the decision-making process had an emotional component. The
finding that trust influenced medical errors suggests that even positive emotions may affect errors. More awareness of the emotional aspects of clinical decision-making and research approaches that address emotion will help
to reduce medical errors and improve patient safety.
The patient was 12-year-old girl, who was admitted to our hospital with gait disturbance and involuntary movements that had appeared 7 days prior. Laboratory tests revealed elevated levels of serum anti-streptolysin O and
anti-streptokinase titers. Doppler Color Echocardiography also showed mild mitral and tricuspid regurgitation.
The patient exhibited the following required criteria: two major diagnostic criteria of Sydenham chorea and subclinical carditis; one minor diagnostic criteria of arthralgia. The Jones Criteria for Diagnosis of Rheumatic Fever
was fulfilled after admission. Recently rheumatic fever has been decreasing rapidly in well-developed countries.
It is believed that there may be many undiagnosed cases because the diagnostic criteria are unfulfilled when the
symptoms of Sydenham’s chorea appear. We propose that it is necessary to consider rheumatic fever with carditis
in the presence of Sydenham’s chorea.