“Medical Errors are No. 3 Cause of US Deaths“. As someone who has spent her entire career working in hospitals, I was interested to see this headline a few weeks ago. I was intrigued by the data, but a little skeptical. Not only have I seen a lot of patient deaths, but it seems relatively rare in my day-to-day life that I see someone reference a death by medical error. However, according to Makary et al in the BMJ this month, it happens over 250,000 times a year.
Since the report came out, two of my favorite websites (Science Based Medicine and Health News Review ) have come out with some critiques of the study. The pieces are both excellent and long, so I thought I’d go over some highlights:
- This study is actually a review, combined with some mathematical modeling. Though reported as a study in the press, this was actually an extrapolation based off of 4 earlier studies from 1999, 2002, 2004 and 2010. I don’t have access to the full paper, but according to the Skeptical Scalpel, the underlying papers found 35 preventable deaths. It’s that number that got extrapolated out to 250,000.
- No one needs to have made an error for something to be called an error. When you hear the word “error” you typically think of someone needing to do “x” but instead doing “y” or doing nothing at all. All 4 studies used in the Makary analysis had a different definition of “error”, and it wasn’t always that straightforward and required a lot of judgment calls to classify. Errors were essentially defined as “preventable adverse events”, even in cases where no one could say how you would have prevented it. For example, in one study serious post-surgical hemorrhaging was always considered an error, even when there was no error identified. Essentially some conditions were assumed to ALWAYS be caused by an error, even if they were a known risk of the procedure. That definition wasn’t even the most liberal one used by the way….at least one of the studies called ALL “adverse events” during care preventable. That’s pretty broad.
- Some of the samples were skewed. The largest paper included actually looked exclusively at Medicare recipients (aka those over 65), and at least according to the Science Based Medicine review, it doesn’t seem they controlled for the age issue when extrapolating for the country as a whole. The numbers ultimately suggest that 1/3 of all deaths occurring in a hospital are due to error…..which seems a bit high.
- Prior health status isn’t known or reported. One of the primary complaints of the authors of the study is that “medical error” isn’t counted in official cause of death statistics, only the underlying condition. This means that someone seeking treatment for cancer they weren’t otherwise going to die from who dies of a medical error gets counted as a cancer death. On the other hand, this means that someone who was about to die of cancer but also has a medical error gets counted as a cancer death. Since sick people receive far more treatment, we do know most of these errors are happening to already sick people. Really the ideal metric here would be “years of life lost” to help control for people who were severely ill prior to the error.
- Over-reporting of medical errors isn’t entirely benign. A significant amount of my job is focused on improving the quality of what we do. I am always grateful when people point out that errors happen in medicine, and draw attention to the problem. On the other hand, there is some concern that stories like this could leave your average person with the impression that avoiding hospitals is safer than actually seeking care. This isn’t true. One of the reasons we have so many medical errors in this country is because medicine can actually do a lot for you. It’s not perfect by any means, but the more options we have and the longer we keep people alive using medicine, the more likely it is that someone administering that care is going to screw up. In many cases, delaying or avoiding care will kill you a heck of a lot faster even the most egregiously sloppy health care provider.
Again, none of this is to say that errors aren’t a big deal. No matter how you define them, we should always be working to reduce them. However, as with all data, it’s good to know exactly what we’re looking at here.