Will Medicine Ever Become Safer?


November 26, 2013

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Hello and welcome. I am Dr. George Lundberg and this is At Large at Medscape.

Hospitals are dangerous places. I no longer work in a hospital, and I try never to go to hospitals even to visit, unless, of course, I or my family were to become really sick and would obviously stand to benefit from hospitalization. I feel almost the same about surgicenters, free-standing emergency rooms, and urgent care facilities.

I published Lucian Leape's seminal paper, "Error in Medicine,"[1] in JAMA in 1994. Fearing reprisal by the American Medical Association (AMA), I deliberately tried, at the same time, to highlight the paper for the medical profession because of the glaring need, and hide it from the public, choosing a December holiday week for publication.

The strategy failed. National Public Radio and the Washington Post saw it and made a big deal out of it. Cries for my termination quickly arose from angry AMA members who did not believe it and cried out, "Whose side are you on?"

I replied, "The side of science, truth, and all patients."

In 1999, the Institute of Medicine published the sentinel report To Err is Human,[2] still a best-seller. They pegged the annual number of American hospital deaths secondary to errors and adverse effects of treatment to be 44,000 to 98,000. In an interview earlier this year, I asked Lucian Leape whether that number still held. He said no, it was much larger. I asked whether we had made any progress. He said yes, but only in narrow fields.

In 2013, a new report[3] in the Journal of Patient Safety estimated American hospital deaths following adverse events at 210,000 to 440,000 per year. Medicare patients are reported to die at a rate of 180,000 per year from or with nosocomial infections and other medical care-related problems.

Most of the attention of the responsive "patient safety" movement has focused on errors of treatment, such as common medication errors and infections. Recent attention has been aimed at problems in diagnosis stemming from recognition that approximately 25% of all malpractice cases allege errors of diagnosis.

This opens a whole new field of study with its own organization -- the Society to Improve Diagnosis in Medicine -- which met in Chicago in August 2013. The society will soon launch a new journal called Diagnosis.

I love the plethora of patient safety activities. We Americans are so good at buzzing around, doing all kinds of "stuff." Organizations, leaders, meetings, grants, jobs, lectures, research reports, news coverage, inspections, threats, penalties, accreditation requirements, even the Joint Commission...what? Where have they been anyway?


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