Are medical errors really the third most common cause of death in the U.S.?

[HuckleB]

https://www.sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s/#more-42052

"It is an unquestioned belief among believers in alternative medicine and even just among many people who do not trust conventional medicine that conventional medicine kills. Not only does exaggerating the number of people who die due to medical complications or errors fit in with the world view of people like Mike Adams and Joe Mercola, but it’s good for business. After all, if conventional medicine is as dangerous as claimed, then alternative medicine starts looking better in comparison.

In contrast, real physicians and real medical scientists are very much interested in making medicine safer and more efficacious. One way we work to achieve that end is by using science to learn more about disease and develop new treatments that are as efficacious or more so than existing treatments with fewer adverse reactions (clinical equipoise). Another strategy is to use what we know to develop quality metrics against which we measure our practice. Indeed, I am heavily involved in just such an effort for breast cancer patients. Then, of course, we try to estimate how frequent medical errors are and how often they cause harm or even death. All of these efforts are very difficult, of course, but perhaps the most difficult of all is the last one. Estimates of medical errors depend very much on how medical errors are defined, and whether a given death can be attributed to a medical error depends very much on how it is determined whether a death was preventable and whether a given medical error led to that death.

...

I’ll conclude by giving my answer to the question that all of these studies ask, starting with the IOM report: How many deaths in the US are due to medical errors? The answer is: I don’t know! And neither do Makary and Daniels—or anyone else for sure. I do know that there might be a couple of hundred thousand possibly preventable deaths in hospitals, but that number might be much lower or higher depending on how you define “preventable.” I’m also pretty sure that medical errors, in and of themselves, are not the number three cause of deaths. That’s because medical errors rarely occur in isolation from serious medical conditions, which means it’s very to attribute most deaths to primarily a medical error. That number of 250,000 almost certainly includes a lot of deaths that were not primarily due to medical error, given that that’s 9% of all deaths every year.

Here are some other things I know. I know that the risk of death and complications is a fairly meaningless number unless weighed against the benefits of medical care, a point that Harriet Hall made long ago, noting for example that an “an insulin reaction counts as an adverse drug reaction, but if the patient weren’t taking insulin he probably wouldn’t be alive to have a reaction.” I also know that Makary’s suggestion that there should be a field on death certificates asking whether a problem or error related to patient care contributed to a patient’s death will be a non-starter in the litigious United States of America, promises of anonymity notwithstanding.

..."

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A very thorough piece that covers the topic and the evidence base over the past couple of decades. Contexts are important here, so reading the whole piece is truly a worthy endeavor.

[whatthehey]

1. The trouble is doctors are loath to correct for confounding in other mortality risks

If they applied this level of concern for multiple mortality causes during their crusades against anybody not as scrawny as a Georgian Belgian peasant for example, then I might take this as mere objective concern for accuracy rather than subjective CYOA.

[maxsolomon]

9. I'm sorry, what?

A Georgian Belgian Peasant?

Are you trying to say that the medical profession should not consider morbid obesity a mortality cause? Because it's a full-blown crisis in this country, and it severely impacts the ability to deliver care at all levels.

[whatthehey]

10. Yes

BMIs were based on Belgian peasants in the Georgian era. The early decades of the 19th Century. In a study not even intended to measure or applied toany health concerns. Thus we have a metric for "health" which renders Tom Cruise obese. The phrase is no different from "Victorian American Literature". Georgian isn't solely a toponym.

Obesity (genuine obesity, not this silly BMI fantasy) should be considered A cause (albeit one with a significant impact on mortality only for those who became permanently very obese at a young age and are also sedentary) just like medical mistakes. But this article cries foul about all the other causes which are confounded with medical mistakes, when neither medical articles nor laypeople acknowledge any other factors whenever a person larger than a medium snuffs it. Jim Fixx gets to have congenital issues. Fat people who outlive him by decades never do. For them, obesity is always THE cause. When doctors worry about confounding causes then, I'll accept that this article is genuine objectivity rather than a cockroach running when it sees a light.

[maxsolomon]

15. Well, that's contrary to what my stepson tells me

He's 3rd year med, and the obesity epidemic is impacting the ability to treat any other issues - for instance, operations made difficult or impossible because they have to work through a tunnel of fat. It's what's know as a complicating factor.

Thanks for the history lesson on BMI. I thought you meant Georgia the country. not too many Belgians there.

[HuckleB]

11. It's an easy out, and it's interesting that any easy out dismisses it all for so many.

Yet, the entire uselessness of alt med nonsense is never enough to keep them from going down those roads.

[CountAllVotes]

2. I believe it

Hell, they've damn near killed me a few times. The last time I was there they asked me about my gallbladder surgery. That's nice I guess except, I never had gallbladder surgery, yet it states in my records that it was removed in 2009. Nope, it is still there with a load of gallstones in it as proof!

Giant moment, believe me!

[HuckleB]

3. Did you read the article?

[CountAllVotes]

4. Yes, and I believe it is "good for business"

These "errors" are costly. In fact, I lost a good friend a few weeks ago due to a medical error. She'd been going from one doctor to the next ringing up bills all over the place and being told nothing was wrong with her.

Alas, she had plenty wrong with her and she is dead now thanks to a "medical error" so to speak.

Corrupt lot of crooks they are IMO.

[HuckleB]

5. You seem to have a lot of anger and vague claims.

But no real response to the content of the article.

Thus, I'm a bit skeptical.

[CountAllVotes]

6. Whatever

I suggest you obtain a copy of your new electronic medical records and see what they have to say.

Mine says I have Crohn's disease which is not the case.

I found records that were those of other persons intertwined with my own records.

I dumped that medical office shortly afterwards as I was a "medical error" waiting to die.

Greedy and stupid, what else can we ask for?

[HuckleB]

7. Oh, goodness.

Thanks for confirming that my skepticism was warranted.

[LanternWaste]

8. If nothing else, self-validation is good for the mind lacking self-esteem in any meaningful way

If nothing else, self-validation is good for the mind lacking self-esteem in any meaningful way, regardless of whether its warranted or not...

[HuckleB]

12. Thanks for the usual derp.

[Horse with no Name]

13. I had medically retired a few years back.

I went back to work this last year.

I worked a per diem shift at a local hospital recently. I had 8 patients on a day shift. There was no Nursing Assistant and no Unit Secretary. There were 2 nurses for 16 patients. We had to do our own orders, give meds, answer call bells, do beds, do baths, answer the phones, direct visitors....everything.
I left that night at about 10 pm after being there since 630 am. I was told that they didn't pay overtime....so I worked off the clock to finish my charting.
It was horrible.
So...yes, with those types of staffing ratios I can definitely see a lot of mistakes being made.

FWIW, I went to an office job. I can't hang with not being able to do a good job unless I donate 3 hours a day to a for-profit company.

[REP]

14. I'm a big believer in science-based medicine

And yes I read the article 😃

The problem, as I see it, is not so much with the medicine itself (though there are exceptions, such as multi-year high-dose HRT for menopause, which isn't a disease and the treatment turned out to be far worse than any hot flash, but that's a rant about medicalizing feminity and for another time). The problem is more often found in the old joke, "What do you call someone who graduated last in medical school? Doctor."

That, of course, is an oversimplification and anecdote is not the plural of data, but as an illustration: in my medical adventures, I've had to tell ER and Urgent Care doctors that I am nephrotic. When that gets the blank stare, I tell them I am in Stage III CRF and I cannot be given NSAIDs. And once, none of that, including "kidney failure" and "no Toradol" didn't work, I had to physically remove the syringe from one young man who is no longer a doctor thanks to that incident. Again, just an example of one of things that can go wrong, and might have been written off as a "bad reaction" had I not been the kind of patient I am.

Is it fair to include noscomial infections in iatrogenic deaths? That's a hard one. When I worked on a medical journal back when dinosaurs roamed the earth, the editorial opinion was not always but more could be done.

Dosing errors are often the result of understaffing, obsolete charting methods, and even language barriers. The doctors may be prescribing the right doses to the right patients, but they are usually not the ones delivering them. And no I won't bother you with my anecdote about that*😄

So yes, the actual percentage of true iatrogenic deaths is difficult to parse, and the reasons for those deaths is complex. The solution is fixing the system - the licensing and monitoring of doctors, proper staffing levels, shift length, charting methods, etc - not getting rid of modern medicine, which continues to improve at an impressive rate.

*my anecdotes about my regular physicians and surgeons are pretty boring, since they are excellent doctors who actually care about me.

[HuckleB]

16. Superficial coverage of medical errors could leave erroneous impression with readers

http://www.healthnewsreview.org/2016/05/superficial-coverage-of-medical-errors-could-leave-erroneous-impression-with-readers/

[marybourg]

17. Yes.

As someone whose DH was just in the hospital 2x and in a re-hab 2x (and nursing homes and similar were not even included in this study) I say absolutely yes. The only thing that prevented his death at least 2x was my watchful presence.

[HuckleB]

18. I'm sorry about you experience with a problematic system, but...

Internet anecdotes do not make such claims true.

[marybourg]

19. In this case

there was a study, not a claim. I was asked if I believed the study and the answer was "yes", based on many years of experience and 2 recent examples.

[womanofthehills]

20. Researchers from John Hopkins Univ did this extensive study - around 700 deaths a day from mistakes

Researchers from Johns Hopkins University did and extensive study looking at the issue of medical errors and the number of lives that are lost in the US every year because of them. Ana Kasparian, Brett Erlich (Pop Trigger), and Kim Horcher (Nerd Alert), hosts of The Young Turks, break it down.

http://trofire.com/2016/05/08/medical-errors-now-third-leading-cause-death-u-s-young-turks/