”Is this true?” The editor emailed me, expressing doubts.
It was a spring afternoon in 2016, and she had attached an article from the British Medical Journal (BMJ) to her e-mail that had garnered a lot of attention in the mainstream media (despite its popularity in academic circles). provoked considerable criticism). The article deduces that medical error is the third leading cause of death in the United States.
I hesitated, not knowing how to answer her questions, not just because I hadn’t had time to read the medical journals—they were relentlessly in my office, in my mailbox, in my e-mail inbox, and, oh well, even in my piled up in the bathroom.
I hesitated because I really couldn’t answer her question. The third leading cause of death? Really? Did Medical Negligence Beat Breast Cancer, Stroke, Alzheimer’s, Accidents, Diabetes and Pneumonia?
terrible data
I have practiced as an internist for 25 years at Bellevue Hospital, one of the largest and busiest hospitals in the United States. I think I’m looking at a reasonable cross-section of current medicine. The vast majority of my patients suffer from diseases from 21st century “developed” societies – obesity, diabetes, heart disease, high blood pressure and cancer.
If medical negligence is the third leading cause of death, then I should always be able to run into it, right? I should have heard such things from friends and family. If medical error were the second most deadly disease after heart disease and cancer, it should be part of my daily medical experience.
But not so. Or, at least, it doesn’t feel like that.
I have certainly witnessed medical negligence and I have certainly experienced medical negligence. I’ve heard chilling rumors in hospital corridors, and I’ve read shocking, heartbreaking stories in the media. Yet these deeds are like exceptions—rare and terrifying. In my clinical practice, deaths from medical error simply do not occur as frequently as congestive heart failure, lung cancer, or emphysema.
And yet, the data on medical negligence keep rolling in. From the estimated 44,000-98,000 deaths per year due to medical negligence in the first report of the American Institute of Medicine in 1999, to more than 250,000 deaths per year in this analysis of the British Medical Journal – medical negligence is close to a public health emergency event. Even if the numbers aren’t entirely accurate (the methodology used in these papers has been questioned), researchers agree that there are plenty of medical errors.
Is this data wrong, or am I wrong? Is it me—and most medical staff—who simply don’t see how rampant medical error is? Are we biased and unwilling to accept reality? We clinicians are killing our patients at an unprecedented rate, but somehow, oblivious to it, oblivious to it? If it does, perhaps we should get rid of our shared shingles so our patients can be spared. We could put a note on the door: “Eat quinoa and beans. Take the stairs. Stay out of the health care system.”
While the “third leading cause of death” claim is likely an exaggeration, the published statistics on medical error are quite different from the experience of the average clinician. The same is true for ordinary patients. Their experiences are also different from the statistics, but at different levels.
As a practicing physician, and occasionally as a patient, I feel that I have to get this thing straight. My experience seems to be very different from the speculation made by the published data. One of us is wrong, and my goal is to find out who is wrong.
Medical also checks for injuries
If the history of medicine in the past two hundred years was made into a feature film, it would be a thrilling epic adventure. Heroes in white coats wield stethoscopes and pipettes, and decapitate diseases with their machetes. On screen, sanitation, antiseptics and anesthesia will rain down from the sky, leveling the diseases of the 19th century.
In the early 20th century, vaccines and antibiotics would explode like hand grenades—saving the masses from the hands of infectious thieves. The superheroes we rejoice in would swagger into the second half of the 20th century and immediately do jiu jitsu 360 degrees—chemotherapy, dialysis, antipsychotics, blood transfusions, contraception, CT scanners, cardiac catheterizations, intensive care units , statins, blood pressure drugs, AIDS treatments – go on the attack, killing every dragon in the room, and almost never looking back.
The movie would be a straight road to conquering the disease gradually, nearly doubling life expectancy before you can reach the bottom of the oily popcorn bucket and grab an unpopped kernel.
Incredible success has long been a leitmotif in the medical world. For good reason! Turning a once-uniform killer into a passing cloud is a remarkable achievement that shouldn’t be taken for granted. But this theme of continued triumph doesn’t leave much room for talk of medical error and poor outcomes of treatment. Medical errors and ill-effects of treatment are, at best, annoying stumbling blocks as our hero struts forward.
Medicine doesn’t check for errors. Morbidity and mortality conferences (affectionately known as M&M conferences) have been a part of medicine for a century. M&M meetings were and still are formal assessments of adverse outcomes of treatment. But the rugged individualism of our medical heroes permeates our analysis of medical error, and our usual response to this is to figure out what — or more often who — is wrong and then fix it . Still, these faults are nothing in the face of this sense of unstoppable progress. All these questions will be resolved in the indomitable advance of medical research.
It should come as no surprise, then, that inventorying medical harm has never been a thriving field in medical research. Gray-haired pundits in the medical world believe that the excellent art of medicine—backed by the overwhelming force of scientific research—delivers exemplary care. In fact, the first person to discover the blind spot was a medical intern.
Resident physician Robert Moser at Brooke Army Medical Center was one of the first to take a hard look at the medical underserved. In a 1956 paper in the New England Journal of Medicine, he described “diseases which would not have arisen without the use of certain medical measures.” This may be the first paper to investigate the damage we clinicians have done – albeit in the name of good healthcare. He titled the paper “The Disease of Medical Progress” and found that about 5 percent of patients experience it.
It wasn’t until the 1980s that researchers began to look at medical harm on a larger scale. However, the angle of the study is not really patient safety, but the medical malpractice system in the United States.
