The CBS Evening News (5/3) reported that research indicates that “medical errors are now the third largest cause of death behind heart disease and cancer.”
USA Today (5/3, O’Donnell) reports that the study authors “wrote that strategies to reduce death from medical care should include making errors ‘more visible’ when they occur, having remedies available to ‘rescue patients,’ and making errors less frequent by following principles that take ‘human limitations’ into account.”
According to the Washington Post (5/3, Cha), “In 1999, an Institute of Medicine report calling preventable medical errors an ‘epidemic’ shocked the medical establishment and led to significant debate about what could be done.” The institute, “based on one study, estimated deaths because of medical errors as high as 98,000” annually. The new research, published in the British Medical Journal, “involves a more comprehensive analysis of four large studies…that took place between 2000 to 2008.”
The New York Times (5/3, Bakalar) “Well” blog reports that the researchers “estimated that an average of 251,454 deaths per year in the United States are caused by medical error.”
Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC:
It’s been known for about thirty years that there are nearly 100,000 deaths per year due to medical errors, with most reports coming from hospitals. Newer tabulations have been used to generate the latest number (above) of about 250,000. The Department of Health and Human Services reported that 180,000 Medicare recipients die each year from medical errors. Some might quarrel with the numbers, but certainly it is clear that a huge number of patients are dying due to medical errors.
The U.S. has a national network of medical schools that tend to be of high quality, and the admissions are so competitive that only smart people get in, so I don’t think that dumb doctors are the cause of these findings.
The numbers that we are discussing tend to be due to errors of omission or of commission, and such errors often begin with poor communication, carelessness, wrong diagnoses, poor training of personnel, and ineffective monitoring routines. Errors may involve nursing or support personnel as well as physicians. Sometimes a sequence of mistakes results in a death, so culpability may be spread around in a particular case.
And then there are the inadequate designs of medical practices including a lack of sufficient safety nets in healthcare facilities of all kinds. In the new healthcare system, there are challenges due to huge numbers of patients, assembly line procedures to augment profits, and corporate management with no knowledge of patient care.
Since stupid doctors are not usually the problem, I have found that the main malfunctions are wrong incentives—especially financial, inattention to detail, ethical lapses, rushing to meet deadlines, sloppiness in procedures and care, and, today, a breakdown in the time-tested details of care. Doctors have become employees. They used to determine the procedures that govern care in hospitals and offices, but now managers who don’t understand how medical care is supposed to work have taken charge.
The safeguards that protect patients are seriously deficient across the country. There are no comprehensive mechanisms to investigate mistakes, and there are no reliable reporting procedures to identify errors and evaluate them. Even in malpractice suits, when evidence of mistakes are often disclosed, legal gag orders prevent the information from getting out.
When I started in practice, my background was at first-rate training institutions where I rarely saw errors. The same was true in the large military hospital where I worked, but things were much different out in the real world of private practice where, as a consultant, I saw mistakes on a daily basis. In US hospitals, over the years, many programs were instituted to identify errors such as establishing intensive care monitoring committees to round in the ICU/CCU to look for quality issues, and we found plenty of questionable care.
As ICU/CCU chairman of our new committee, I recall going to the medical staff to inform them of our rounding plans. The President of the staff, an arrogant surgeon, reacted by saying, “Nobody is gaining access to my patients’ charts.” But we won that battle and were empowered to intervene when necessary. We also were enablers for our highly trained nurses to be able to question the orders and plans coming from the doctors.
Other procedures to prevent errors have been devised, but obviously, not enough is being done.
The surgeon from Johns Hopkins who was the lead author of the study above pointed out that our society spends fortunes on cancer and heart disease care, but very little on the third leading cause of death——medical errors. This problem has not been widely recognized, and it is an issue around the world. It is likely that many of the errors are preventable if only funds were available to tackle the issue.
I might add that a huge arena which has not been analyzed at all is that of the private medical office practice. Most doctors are trained in hospitals. Then they open offices where there are many quality challenges. Some doctors have been very good at following the standards of good medicine, while other office practices are awful, dangerous places. Today, with corporate incompetents in charge of offices, I find that it is rare for me to interact with an office practice and not find something worrisome going on.
What to do? The first thing is for organized medicine to reclaim the traditional doctor-patient relationships and then get strict with doctors regarding their priorities (“Always place the patient first” is a traditional primary value of the medical profession.) And the government needs to finance innovative approaches to saving lives threatened by errors.