In your own words, explain why or why not the perspective of the patient is the most important determinant as to whether an adverse event has occurred.

      I do not believe that the perspective of the patient is the most important determinant as to whether an adverse event has occurred.  Basing patient safety strictly by adverse events that occur deemphasizes any errors that occur that do not lead to harm.  Such errors, especially of the "near miss" category where the errors would most certainly have led to serious harm if they hadn't have been caught beforehand and prevented are never reported to the patient, yet it is vital to determine the root causes behind these errors.  In other cases, errors actually happen that do not lead to harm, such as giving the wrong dose of the right medication or a dose of a harmless, yet incorrect medication such as acetaminophen (Ransom, 2008, p. 244).
     The very definition of "adverse event" includes a great number of actual medical treatments simply because some form of harm or injury occurs to the patient.  No errors at all occur in the delivery of care.  There is just risk involved.  "Some argue that such events are not adverse and should not be considered as harm; instead, they see such events as known complications or risks of certain procedures and interventions (Ransom, 2008, p. 244)."
     The very nature of practicing medicine entails risk, much of which is not within the control of the medical providers.  I am referring to patient compliance, which is not only an issue pertinent to this topic of reporting adverse advents, but also to the adoption of Accountable Care Organizations that will hold physicians responsible for outcomes despite patients themselves having a large responsibility for their own health.  Patients often choose to not follow doctors' orders correctly and engage in self-destructive practices, further balancing the scales toward adverse events occuring beyond where they exist already due to natural complications due to things such as post surgical infection or medication intolerance. 
     Americans want Rolls Royce medical care for the price of a Honda, if not for free.  Despite signing legal forms acknowledging the risks involved with medical and surgical interventions, many expect miracles and are willing to find an attorney willing to gamble on a settlement offer when not satisfied with the outcomes. 
     I do not believe that patients, as lay people, are qualified to determine the occurrence of adverse events.  Epidemiologists or others professionally trained in collecting such data are better qualified.  Ideally, a group of professionals that is impartial to the process could be inserted into the process that could also address the problems of underreporting that occurs in medical institutions of errors and adverse advents.

Reference:

Ransom, R.R., Joshi, M.S., Nash, D.B., and Ransom, S.B. (2008).  The
     healthcare quality book, 2nd Ed., vision, strategy, and tools.  Chicago,
     IL:  Health Administration Press.

                I just got back from a trip to Durham, North Carolina.  It was a dual purpose visit.  On one hand, I was visiting my alma mater, Duke, which I hadn’t seen in many years.  I was able to revisit some old memories, and the timing couldn’t have been better for dropping by Cameron Indoor Stadium.  There was a basketball camp in progress hosted by Coach K, and I was able to see numerous alumni there, including Christian Laettner and current Magic players Chris Duhon and J.J. Redick.  The main purpose of the trip, though, was to accompany my mother to see her doctor for lymphoma treatment.  She has a local doctor, but the disease has reached a point where the current therapy is ineffective. 

                I used to work at Duke’s Comprehensive Cancer Center while a student, but it is now a huge new complex.  The labs are drawn on the first floor, and the clinics are on separate floors differentiated by specialty with a total of six floors.  I realize that I come with a personal bias, but I left with a reinforced impression of why Duke Hospital is synonymous with high quality.

                The building is spotless and designed with patient ease in mind.  There is excellent lighting with open windows showing the natural beauty of gothic buildings that surround the site.  Directions are clearly presented to main areas, and there are colored zones to differentiate separate clinical areas of the cancer center (ex. purple zone, orange zone).  Upon check-in, patients are given a buzzer similar to restaurants (Olive Garden or Outback Steakhouse), even though the waiting areas are so large and open with multiple televisions, magazines, and refreshments that it is unlikely that one would leave the waiting area.  There are even five large screen computers with internet access in the waiting areas to manage the wait times.

                The more intense the medical problem, the more important quality is to a patient.  Ultimately, we were there for the care of the specialist.  After looking at my mother’s labs, the doctor needed to perform a bone marrow biopsy.  The doctor and his nurse stayed until 7 p.m. to complete the job, and they couldn’t be nicer.  Follow-up care is coordinated with the doctor here in Orlando (who trained with the Duke doctor), and test results are available to my mother on the internet. 

                Although some things at Duke were the same, much had changed.  I certainly felt older as I saw my old dorm and the buildings that were now standing in the places of ones that were torn down.  In the case of the medical center, it is clear that the progress is for the better.

P.S.  As we left town, we stopped by Cameron Indoor Stadium, and here's a picture of my dad with Chris Duhon.