Who Believes That Medical Error Is the Third Leading Cause of Hospital Deaths?

Laura A. Stokowski, RN, MS

Disclosures

May 26, 2016

Utter Nonsense

Among the words we can publish that were used to describe Makary and Daniel's study findings were: "garbage," "tripe," "extrapolated hogwash," and "bogus." Still others described them as "outrageous," "absurd," "insulting," and "a joke."

An internal medicine physician from Europe wrote, "The time has come when people won't die from their disease anymore—suddenly everyone will die from medical error? This is nonsense. From this article, you would think that doctors in the United States are dragging healthy people in off the streets and finishing them off."

A surgeon speculated that the investigators were "fishing for funding" with their study, and another physician believes that "starting a witch hunt to root out medical error is misguided at best, and patently dangerous."

An internist questioned both the credibility and the gravity of the findings, saying:

These numbers are total nonsense. It has been shown repeatedly (curiously left out of this article) that patients dying as a result of "error" are almost uniformly frail, weak patients whose life expectancies are short (ie, 6 months or less). These are not healthy individuals dropping dead from medical error. And the large majority would die from their conditions if it were not for major ongoing medical care. Moreover, any hospital-acquired infection or fall is considered an error. While I agree that reducing these events as much as possible is laudable, it defies common sense and practicality that these can be eliminated entirely. This is not a call to mediocrity, but an indictment of the methods used to calculate these results. Too often people want a grabby headline but don't present the whole, more complicated story. In the meantime, we lose patient trust. I urge a bit more responsibility.

An oncologist criticized the study as "just another example of the endless ways to demean medical personnel. What a piece of hooey. I've seen plenty of people 'saved' from dying only to perpetuate their misery. Just walk through your local intensive care unit to witness it firsthand. The authors would have us believe that without medical errors, no deaths would occur—ever."

Sarcasm also crept into more than a few other comments, like this one: "I guess people should stop going to the doctor so they don't risk getting cut down in their prime." And there were comments from those who view the study findings as just more fodder for the legal profession.

Still others simply did not believe the results because they didn't jive with personal experience. An emergency medicine physician wrote, "I have been in medicine for 45 years and have not seen this to be even remotely true."

Doctors in Denial?

Although few in number, some Medscape readers accept that Makary and Daniel's findings may be valid and believe that physicians who think otherwise are in denial about the scope of the problem.

A pediatrician wrote:

Medical errors are hard to accurately quantify. They are hugely underreported and sometimes it's very hard to tell whether an error caused significant harm. I do want to point out the Dunning-Kruger effect[8] that plagues medicine in certain areas where people are practicing at the edge of their scope and not appropriately asking for guidance. Be careful of the ego and try to be aware of what you don't know.

A registered nurse was saddened reading some of the comments made about the study, saying, "Instead of asking what we can do about this problem, most are variations on exclamations of denial." Another healthcare provider concurred, saying, "Errors and complications are frequently faced by patients, even if doctors refuse to admit it. Why do so many women die from heart attacks after being sent home from the emergency department with a proton pump inhibitor or an antianxiety medication after being seen for chest pain?"

Error Happens, and It's Not Always Preventable

Many physicians acknowledged that medical error is common but they disagreed that all errors are preventable, and many were disinclined to place the responsibility for errors on the shoulders of clinicians.

A general practice physician wrote:

Cognitive-proximity biases; the Kübler-Ross sequence of denial and anger; the psychological need to assign blame; the risks associated with procedural management of cancer or cardiovascular disease in an unstable, aging population; and retrospective cause-and-effect attributions are all driving factors in random catastrophic lethal events being attributed inappropriately to healthcare provider-caused errors.

Preventable systematic lethal or egregious human errors do occur, but overall they are relatively small in number compared with random, unpreventable events. Oversight efforts to prevent these errors (eg, electronic health records) can have the opposite unintended consequence of increased random events, because quality provider-patient clinical 'face time' is reduced.

Another clinician acknowledged that many people die or are injured because of medical errors, but the true number is unknown. "While the issue deserves attention, the 'global warming-esque' hyperbole is not helpful and is in fact counterproductive."

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