Saturday, May 14, 2016

Guns Don’t Kill People as Much as Medical Errors Do

Real Time Estimate
Top 7 Non-Disease Causes of Death 
Since 1 Jan, 2013
To Date
Medical Errors:
Alcohol Abuse:
Vehicle Accidents:
Drug Abuse:
Firearm Homicide:
                   Data from National Vital Statistics Report
Looking just at medically-related deaths, cancer and heart disease claim half those who die in the United States every year. But recent studies suggest that medical malpractice slides into a solid third place on that medical list. It’s been hard to track deaths from medical malpractice, because listing such errors on death certificates are a tacit admission of fault, a clear and easy path for lawyers pressing medical malpractice claims to clean up with little or no effort. So there’s no billing code for “screw-ups.” But misdiagnoses, prescribing the wrong drugs or surgeries gone wrong have now been measured by experts through back-door statistics.
Research reported in The BMJ (formerly the British Medical Journal), led by Dr. Martin Makary, surgical director of the Johns Hopkins Multidisciplinary Pancreas Clinic and a professor of surgery at Johns Hopkins Medicine, “evaluated four separate studies that analyzed medical death rate data from 2000 to 2008, including one by the U.S. Department of Health and Human Services' Office of the Inspector General and the Agency for Healthcare Research and Quality. Based on 2013 data on hospitalization rates, they found that of 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error. They said that adds up to 9.5 percent of all deaths a year in the U.S.”, May 4th.
Cancer and heart disease, along with a long list of other less fatal diseases, get lots of research money, studies aimed at curing and extending mortality. Fix a process filled with flaws… where admitting you even have a flawed process that could give rise to legal liability? Not so much. “But there's a Catch-22 when it comes to committing resources to reduce the problem of medical errors.
“‘One of the big issues that we in the patient safety research field face, that we run up against, is a problem where there's very little funding for research in making care safer and better. Part of the problem is that our national funding is informed from our national health statistics. But those statistics don't recognize medical care gone awry as a cause of death,’ said Makary.”
One of the biggest arenas of “death by medical mistake” is clearly emergency care. ERs where sleep-deprived, resident-supported doctors, make split-second decisions… and God help you if that emergency occurs on a weekend, when more senior doctors have opted to spend that time with their families… leaving less experienced hands at the wheel. According to, there are particular emergency surgeries (underlined below) that have the worst mortality statistics, noting that planned versions of these procedures do much, much better.
·         The procedure that accounted for the highest burden in the study was a partial colectomy, or removal of part of the colon…
·         [Next we have] “Small-bowel resection … a procedure that removes part of the small bowel… ranked high on the list because patients who need this procedure done are also often very ill, which can lead to further complications…
·         Emergency gall bladder removal [ooops, I had this,] when it's done emergently[,] it's for severe infection or blockage of the gall bladder which can make you very sick… Peptic ulcer… surgery is one of the lowest frequencies on the list, but has one of the highest rates of complication and mortality…
·         [A]bdominal adhesions [often the result of earlier surgeries] can lead to serious complications, which can make treating them with emergency surgeries risky.
·         [Appendectomies - me again - made the list simply because there are so many of them.]
·         A laparotomy is a procedure done to open the abdomen, when no other treatment is performed. The researchers found this procedure wasn't very common but had a very high mortality and complication rate.
So exactly how do we approach this third leading medical cause of death in this country? “Medical errors can take a number of different forms, including diagnostic errors -- missing the correct diagnosis due to substandard evaluation of a patient -- and drug mishaps. Unnecessary surgery, not calling in a specialist when one is needed, and missing life-threatening conditions such as septic shock also feed into the problem. Most such instances reflect system-wide problems, such as poorly coordinated care and inconsistencies in insurance coverage, among other issues, and cannot simply be blamed on ‘bad’ doctors.
“‘Human error is inevitable. But while we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences,’ Makary wrote in the study… The first step to reducing the problem, he suggests, is to deal with it more openly when things go wrong: ‘Make errors more visible when they occur, so their effects can be intercepted.’
“‘We've spent a tremendous effort tracking cancer, by state, by subtype, and we report all that to our national cancer registry. But we don't do any of that for people who die of medical error gone wrong,’ said Makary.” Kill a few more lawyers along the way?
I’m Peter Dekom, and having a go-to doctor to call in the event of an emergency – someone who can make sure the rights experts are there for you when you need them most – is one giant step we call can take to lessen the risks.

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