>The researchers caution that most medical errors aren't due to inherently bad doctors, and that reporting these errors shouldn't be addressed by punishment or legal action. Rather, they say, **most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability**.
correction: as u/redheadedwoodpecker pointed out - *Actually, the article says it's third behind cardiac and cancer, and ahead of respiratory, which is fourth*
I'm currently involved in a study on medical errors (particularly prescribing errors) as part of my MD. I would take this result with a gigantic grain if salt.
There are dozens of articles which try to inflate the number of errors and their impacts, usually through creative definitions.
In this study, the definition essentially included any situation where results differ from the clinical plan. Outside of palliative care, death is very rarely part of the clinical plan so that could include just about every death in hospital as a medical error.
The type of research they're doing is important (that's why I'm doing it!) but only if it's used to improve systems which prevent or catch errors. Fearmongering like this is just a cheap way to get references to your paper.
It's interesting to read this thread. Doctors often try to remember that many people coming to the hospital - especially the emergency department, where I work - are having the worst day of their life to date. And the frustration expressed in many experiences recounted here is understandable.
I think there are two things to keep in mind: first, that a "medical error" in this context is not saying that the patient would not have died anyway as the ultimate outcome of their illness, but rather that preventable errors in their care - including errors of omission - can be identified as precipitating factors in how they died. So, if someone had an infection but failed to get an appropriate antibiotic within the timeframe that is standard of care, their death could be attributed to medical error. The patient still might have died even if given the antibiotic, especially if they had other complications - but we can't know. And no matter what caused the delay, it doesn't change this label.
Second, errors do happen, and they're common. It's scary. However, just because the story changes during the course of your treatment - you were told one diagnosis, and then another by a different doctor, for example - does not mean you experienced one. It's vital that we revisit what we've learned both from tests and the patient's response to therapy, but when it's busy we don't always communicate our logic well. It can be infuriating to experience - *why didn't the first doctor say it could just be a muscle spasm? I've been here for hours, and they're not even going to do anything! And didn't the nurse say I was supposed to get an MRI?* - and it's a bummer to have that be what you remember about your visit or appointment. That doesn't mean it's unreasonable. Many diseases have little or no objective data that define them. Many diagnoses are diagnoses of exclusion, meaning we have to rule out a bunch of other stuff before it can be applied. Maybe you were only supposed to get an MRI if your blood test was positive, but a lot of information was thrown at you and you didn't catch that. You can leave saying you got bad treatment and that's fair - good patient communication is something we aspire to. But in most cases, that failure to communicate was the only error, and everything else behind the scenes was within standard of care.
Note that medical error does not mean the doctors actually made an error. It could also mean an issue with diagnosis or incomplete information. If a patient didn't know they were allergic to a certain medication and end up dying because they were prescribed it, this is a medical error and yet everyone did everything perfectly right; there was just no way to know that this patient would react poorly to medication that normally works perfectly.
Actually, the article says it's third behind cardiac and cancer, and ahead of respiratory, which is fourth.
When there are thousands of possible diagnoses and an incorrect one without the proper tests leads to death within several hours. And you also have the public breathing down your neck about wasteful tests driving up healthcare costs. Do you want affordable healthcare, or do you want $50,000 in tests for every person entering the emergency room.
What these types of articles fail to consider is that people are supposed to die. The error in most cases is continuing futile efforts for the sake of profit on the provider part or poor understanding and naivete on the patient or surrogate's or everyone's part, rather than appropriately transitioning the patient to hospice and palliation. These studies classify any action that does not result in the perpetual immortality of a person as an error.
People don't just die of one thing, even with heart disease and cancer. Even those conditions are frequently survivable without intervention. Almost everyone has basal cell and thyroid carcinoma and tons of others at some point and doesn't die. You scratch it off with a fingernail, maybe your immune system knocks it down. People die only when their overall health has over the course of their life of permissive abuses and neglects of self accumulated to a point when the body fails to recover from insult. You die when so much of you is diseased that the disease becomes you and your ability to maintain homeostasis fails.
Sometimes with heroic efforts you can be coaxed back to stability tempprarily until the next insult. Sometimes not. The sicker you get, the more thousands of things go awry. A really sick patient with a prolonged inpatient course can be discharged with hundreds of active diagnoses. The current coding system ICD-10 codes for over 68,000 unique disease states.
At some point the dysregulation proceeds where with even unlimited resources for diagnostic and therapeutic interventions, it is impossible even to diagnose let alone treat the ever expanding cascade of illness. At that point, failing to identify and correct a problem isn't an error, it's an inevitability. And this is what most people die from, because their doctors are naive and think they can fix most things regardless of the circumstance.
They can't, but they can get paid for trying, and if you insist that they do, they will. And familys over 95% of the time in my humble experience insist upon it. It takes a wise sage of a treating physician to guide them with confidence to palliation and comfort which pays him or her nothing rather than the highly profitable torture and expense of futile treatment. Medicine has let the world of business creep in on every level, and you should expect treatment decisions to be increasingly in line with profitability by and large.
When I am consulted on a patient that has had a protracted course of decline in function, failure to thrive, accumulation of morbidity and disability, even if they have a problem that is correctable with interventions, the family and I have a discussion about whether what we would be doing is just prolonging the inevitable. Sometimes family memebrs need to travel from afar to pay their respects, atone for fallings out, or come to terms. Sometimes then we will expend the resources for the wellbeing of the surviving family. Other times we transition the patient to hospice care which is by far the best and least expensive end to life.
I've been a healthcare worker for several years now. Let me tell you why I think this is a problem with no signs of improvement.
Over the past decade or so and on into the future the healthcare industry is being consolidated into fewer businesses. Many claim to be nonprofit organizations, and may be on paper, but believe me they are very much for the profit of an elite few. Think of it like the food industry, there is now a McDonalds EVERYWHERE, they are huge, yet their food is shit. You may eat there, sure but their food is shit. Fast food is designed to squeeze every penny out of the business. The fast food industry works this way to get profit at the least expense, this includes staff, safety, quality.
Everyone knows the joke that the box of tissues was the cheapest the hospital could find and they will charge you as much as they can for it.
**The worst of all is the staffing.** They cram so many patients into the least amount of staff, because this is the biggest expense to a healthcare company, the staff. So you have nurses and doctors taking care of more patients than they can keep track of. **It is like someone trying to boil 100 pots of soup at a time, stirring in ingredients with every pot with the lid on tight and trying to keep them all from boiling over.** This is healthcare. Pots boil over all the time because staff are just spread way too thin to save money on staffing. As the healthcare industry continues to get consolidated into fewer and fewer organizations (corporations) this problem will remain and may get worse.
Because you're reddit I know most of you have seen fight club and the story about the choice of a recall as cost equation instead of a life saving measure. This is what healthcare is becoming, and let that really sink in.
I currently work for one where my workflow is so high that it is literally impossible to perform all of the duties I have. The critical thinking that everyone always hears about in healthcare is most applied to **which corners can be most safely cut** without endangering my patients because to provide every single measure of care and fulfill all of my duties just isn't possible. My coworkers and I are constantly lectured because we don't clean beds fast enough, or turnover patients fast enough or don't get patients to radiology fast enough. Most of the time this is by a boss that is forced to scold us for failing to perform responsibilities that he or she even knows aren't all possible but their superiors make them pressure us anyways.
Frankly I'm a bit scared to see which of the many things I've seen is the thing that takes my life one day. Mostly I'm mortified about the care that I will receive when that time actually comes.
Go ahead and downvote me for being grandiose or embellishing, or saying the insurance companies are the problem (and they are one of many diseases of healthcare). I'm not telling you all this for the internet points, I just really want change because I got into the field to help people and it is a depressing state things are in.
I take issue with the language of the article in claiming medical errors are a major cause of death.
If a patient is having a heat attack and it is misdiagnosed as heart burn and the patient dies, medical error did not kill the patient. The heart attack did. Proper medical intervention may have changed the outcome, but failure to provide it was not the cause of death.
Medical error should only be listed as the cause of death if a medical decision directly kills the patient. Such as a surgeon accidentally slicing an artery or a nurse administering a massive dose of the wrong medication.
Conflating the two to inflate numbers is asinine, does no one any real favors, and muddles the discussion about how to properly address medical error.
So we have a system that consistently falls short of providing essential care and overcharges for the care that IS provided. In many cases, the only way people can pay for the procedure(s) they need is if they sue someone. Call me crazy, but I think this is the exact opposite of the way it should work.
All it takes is one little mistake. My mom started a stroke right in front of me. Couldn't talk or move her left side. At the ER no one came to her room for 10 minutes ( there is a 3 hour window to give tPA which breaks up a clot like Drano for a sink). Turns out when a clerk entered arrival time they accidentally hit the 1 on the keyboard before 2.30; the nurses and doctors thought she arrived at 12.30. Not enough time left to CAT scan to rule out aneurism. I showed my 911 call on the cellphone and within 5 minutes had two doctors and two nurses on it. She got it (tPA) within the 3 hours and within 10 minutes was talking and moving again.