It was revealed earlier this year that medical malpractice is the third most common cause of death in the United States – third only to heart disease and cancer, perhaps the 2 most-feared conditions known today.
The study by Johns Hopkins School of Medicine made breaking news when it found that preventable medical errors accounted for approximately 251,454 deaths in 2013, or a staggering 700 deaths per day.
Yet, if you were to take a look at the CDC’s list of leading causes of death, you won’t see any mention of medical error. You won’t find “medical error” as an underlying cause of death on a death certificate, either. When it comes to assessing causes of death for official documentation, any suggestion that doctors ended a life when expected to save it is purposely covered up.
This certain type of ignorance towards the magnitude of the problem that allows it to continue. As the health industry’s best-kept secret, medical mistakes and injuries don’t get the attention – and therefore, funding – needed for reform. But researchers are still trying to get to the bottom of this nightmare.
The Numbers Are through the Roof
Taking into account every study into the dangers of medical errors in the past 2 decades, the number of deaths and injuries believed to be the result of mistakes has ranged significantly. In 1999, the Institute of Medicine (IOM) patient safety report “To Err Is Human: Building a Safer Health System” estimated 98,000 preventable deaths per year; in 2013, another study suggested over 400,000.
Although the Johns Hopkins study, co-authored by Drs. Martin Makary and Michael Daniel, has come closer to discovering the true number of deaths, we might never really know the full scope. Robert Wachter, MD, of the University of California, San Francisco now suggests that even Makary’s and Daniel’s findings may not be accurate; in fact, they could still come up short.
This is because – unlike for epidemics with natural causes – there is currently no system in place to track all fatal errors made in hospitals, nursing homes, and outpatient clinics. Why? Put simply, these incidents go notoriously unreported.
Inside the System: How and Why It Fails
The Office of Inspector General reported that hospital incident reporting systems captured only 14 percent of patient harm events. Since nobody wants to admit their mistakes, accurate data is nonexistent.
On one hand, experts argue that the number of deaths incurred doesn’t matter. Donald Berwick, one author of the “To Err Is Human” report, believes that “Whether it’s the third, or the fifth, or the ninth [cause of death] doesn’t matter. [Medical error] is important, and we need to get to work on it much more systematically than we have.” The fact is, even the smallest number of estimated deaths is big enough to ring alarm bells.
On the other hand, however, finding a conclusive number could be crucial. The CDC’s list of leading causes of death has a considerable impact on which disease control initiatives receive funding. Therefore, “If it is 250,000 people a year dying versus 100,000,” Wachter argues, “the level of priority that it gets in healthcare systems and among regulators and funders would probably be different.”
“To Err Is Human” – but Erring to This Extent?
Makary and Daniel define medical error as anything from lapses in judgment or skill to communication breakdowns. Of course, doctors are only human. But not only is the number of genuine medical mistakes astronomical – doctors are also unwilling to own up to unprofessional conduct. Meaning these numbers may be far higher than any study has suggested.
In 2006, for example, the IOM found that there are 1.5 million preventable adverse drug events each year, and “the true number may be much higher.”
These events incur huge monetary costs for patients, families, and healthcare providers – but still more medication errors cause serious injuries and can even cost lives.
Tejal Gandhi, MD, MPH, president and CEO of the National Patient Safety Foundation (NPSF), reported recommendations for accurately measuring medical errors last year. According to Gandhi, healthcare institutions will need to pay more attention to how they deal with the mistakes themselves. “People won’t talk about errors at all if they think they’re going to get blamed, punished, or fired,” he noted. “It will just get hidden, and then we’ll never learn and improve.”
An Ongoing Battle for Patient Safety
Given the “effort” being put into healthcare reform today, the medical malpractice epidemic is as disturbing as ever. While healthcare providers scramble to find ways to improve patient safety – blaming incidents of injury and fatality on uncontrollable circumstances – they need to start looking closer to home.
It seems that the key to improving patient safety is awareness. Through accurate reporting, medical malpractice is more likely to be taken seriously by the government and thus get the funding it deserves.
With this in mind, Makary and Daniel asked the CDC to make 2 changes: update the list of common causes of death to include medical error, and add the option to report medical error as an underlying cause of death to death certificates. Wachter, on the contrary, suggests avoiding self-reporting altogether; instead using systems like the IHI Global Trigger Tool for Measuring Adverse Events to monitor events.
Either way, without knowing exactly what’s going on in our hospitals, we can’t hope for federal funding to relieve the problem. As Makary and Daniel quite rightly argued in their appeal to the CDC, the U.S. government and private sector invest heavily in heart disease and cancer research. So why can’t the country pool adequate resources for quality care and patient safety?