Table 4 Organizational problems inhibiting the reporting of clinical errors by the healthcare team from the physicians’ perspective

Organizational problems

Problems in the hospital

Severe chastisement by senior physicians

1. The tendency to severely chastise the interns has resulted in failure to report clinical errors unless catastrophic ones.

2. In most cases, senior residents on the ward fear being chastised by their professors and therefore treat the interns with undue harshness.

Unconventional punishment

1. Even a minor clinical error will have severe repercussions and will bring on the distrust of professors and other physicians.

Lack of close monitoring in high risk cases

1. In case of an emergency or during the night shift, professors rely solely on reports provided by aides.

Long shifts and high workloads

1. Trainees may sometimes work in consecutive shifts over several days causing fatigue which minimizes their ability to report clinical errors.

Lack of standard forms for reporting clinical errors

1. To date, there have been no already prepared forms for recording and reporting clinical errors.

Problems related to external factors

Legal loopholes

1. Failure to obtain informed consent from patients for therapeutic intervention and its associated risks at training hospitals.

2. The majority of patients visiting university hospitals are often financially disadvantaged.

Lack of compatibility between legal sentences and standards

1. Lack of the needed devices and facilities for performing medical procedures at university hospitals or the faulty operation of the existing devices may result in a clinical error during an essential medical procedure, but the law imposes penalties similar to those in developed countries with standard equipment and devices.

Subjective view

1. The physician is considered by law as the sole perpetrator and condemned as such.