Medical Errors – Third leading cause of death

According to a study published in the British Medical Journal (BMJ) recently, medical error is the third leading cause of death, after heart disease and cancer.

Medical Errors – Third leading cause of death

The researchers examined four studies that analysed medical death rate data in the United States, from 2000 to 2008. Then, using hospital admission rates from 2013, they extrapolated that, based on 35,416,020 hospitalisations, 251,454 deaths stemmed from a medical error.

That number of deaths translates to 9.5% of all deaths each year in the US — and puts medical error above the previous third-leading cause, respiratory disease.

The new estimates are considerably higher than those in the 1999 Institute of Medicine report “To Err Is Human.” However, the authors note that the data used for that report “is limited and outdated.” That doesn’t even include doctors’ offices and ambulatory care centres, only inpatient hospitalisation resulting in errors.

Accurate and transparent information about medical errors is not captured on death certificates, which are the documents the Centers for Disease Control and Prevention (CDC) uses for ranking causes of death and setting health priorities. Death certificates depend on International Classification of Diseases (ICD) codes for cause of death, so causes such as human and system errors are not recorded on them.

There is a suggestion that adding a field to death certificates to indicate medical error is likely to get medical errors the attention required to bring about more research. However, it was pointed out that hospitals have no incentive to publicise errors; neither do doctors or any other provider.

To say that the article has created a storm of controversy in the medical community in the US, is an understatement.

There is a call that the article has unfairly condemned the US healthcare system and a call for BMJ to retract the article and issue an apology to the US medical community. The BMJ, to their credit, have stood their ground and responded with “We do not believe there are any grounds to retract the paper, and are not considering this course of action.”

Medscape Medical News covered this analysis with the headline “Medical Error is Third Leading Cause of Death in US.” Subsequently, more than 500 Medscape readers expressed everything from frank disbelief to admonishment for dissemination of the study’s findings. Readers who found the study results credible and thought-provoking were decidedly in the minority.

I find it interesting that only a minority of respondents found the study “thought-provoking”. Isn’t the point here that people are dying from medical errors. This should not be a discussion about the fine details of the study. It should be a discussion about what can we do to decrease the incidence of reported medical errors, regardless of the numbers.

It is the same mentality we see with studies on diet, supplements and other therapies in the treatment of autism. Focussing on statistics and fine details of the studies, rather than saying “isn’t that interesting?” What are the unique characteristics of those individuals that respond well? How can we identify them? Isn’t that what scientific curiosity is about? Making an observation and following it up, rather than dismissing it because it doesn’t fit with the accepted medical paradigm.

“Some readers took Medscape to task for reporting on an inflammatory study that gives ammunition to the uneducated public and personal injury lawyers. A physician assistant pointed out that the study’s title and the Medscape news headline were misleading since the study actually focused only on deaths that occurred in the hospital, not all deaths.”

Nothing that the biomedical community, trying to heal their ASD children, haven’t had to deal with for years from misleading headlines, biased reporting and condemnation from the medical community.

“Another irresponsible article is going to create more panic and mistrust of the medical profession. There are no data; mere suppositions and extrapolations of extrapolations. But once you launch a figure like 200,000 deaths, it will be impossible to cancel it from public opinion.”

Finally, comments from those opposed to the study. Hardly what you would expect from well-educated scientifically minded doctors.

‘Among the words we can publish that were used to describe Makary and Daniel’s study findings were: “garbage,” “tripe,” “extrapolated hogwash,” and “bogus.” Still others described them as “outrageous,” “absurd,” “insulting,” and “a joke.”’

‘An internal medicine physician from Europe wrote, “The time has come when people won’t die from their disease anymore—suddenly everyone will die from medical error? This is nonsense. From this article, you would think that doctors in the United States are dragging healthy people in off the streets and finishing them off.”’

‘Sarcasm also crept into more than a few other comments, like this one: “I guess people should stop going to the doctor so they don’t risk getting cut down in their prime.” And there were comments from those who view the study findings as just more fodder for the legal profession.’

And some more sensible comments from the minority, that are willing to perhaps consider that the study has value for open discussion.

A registered nurse was saddened reading some of the comments made about the study, saying, “Instead of asking what we can do about this problem, most are variations on exclamations of denial.”

A pharmacist wrote:

It is appalling how cavalier many practitioners seem from their comments, instead of taking this deadly issue seriously. Grown men and women, with advanced medical and allied health degrees, are sniffing and discounting the reality of healthcare-induced harm when we all know it exists. Perhaps this study is not the Holy Grail, but don’t kill the messenger just because you don’t like the message.

A family physician concurred. “OK… let’s really study this. Healthcare is far from perfect. Instead of getting angry and dismissing the study, we need to take a good, hard look.”

A similar sentiment was expressed by another reader in response to the many comments from peers who dismissed the study out of hand. “One would hope that a study that exposes the high rate of medical error would generate a physician drive to investigate, confirm or deny the findings, and seek solutions. It is very disappointing to see an unwillingness to acknowledge a potentially serious problem.”

A family physician recounted some personal experiences in support of the study’s findings.

I recently sat at the bedside of friends who were hospitalized. It was a terrible, eye-opening experience. I saw equipment not working properly, arrhythmias and anoxia ignored, and delirium completely missed. I saw a large glass of juice given to a patient an hour before a surgical procedure, with the rationale that “It’s OK because the patient’s blood sugar is low.” I saw incompatible medications being given together, with the justification that “If the patient goes into V-tach, it’s OK; she’s in the hospital.” On and on it went. My friends are dead now. I just hope your loved ones don’t end up in the hospital so you can see for yourself just how bad it can get.

And finally, this insight came from a pathologist: “To measure the present value of the healthcare system, we would need to know the death rate from no medical care.”

Medical error—the third leading cause of death in the US.