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

Laura A. Stokowski, RN, MS

Disclosures

May 26, 2016

Systems, Not Humans, Cause Error

Other clinicians from the "error happens" camp believe that systems, not humans, are largely to blame for errors. A registered nurse explained. "System errors, not people intent on making mistakes, are the main culprit. Tort reform is much needed because many family members who feel the pain of loss are eager to punish someone for a loved one's death."

Another healthcare professional expressed the view that the label "medical error" is unfortunate. "Medical error is more than physician error—these results don't point the finger at physicians. Physician defensiveness is not warranted, but these high rates suggest systems problems, and root-cause analysis is indicated."

A physician agreed with this statement and responded:

You bring up a valid point that a lot of doctors are missing because they see this headline as a direct threat to them and their livelihood. Errors are not the fault of physicians but of systems. Human disease and top causes of death have changed from acute infections to chronic problems, but the mindset that drugs and interventions that worked so well in the past are also the solution in today's world is wrong. It is a sign that medicine needs to change with the times. We should be putting more emphasis on preventive medicine, holistic approaches, and physiological nutrition, because the drugs and interventions are doing nothing to stop the top killers.

Blaming the Messenger

Medscape was in for a share of the criticism, by virtue of reporting Makary and Daniel's findings as news. Some readers took Medscape to task for reporting on an inflammatory study that gives ammunition to the uneducated public and personal injury lawyers. A physician assistant pointed out that the study's title and the Medscape news headline were misleading since the study actually focused only on deaths that occurred in the hospital, not all deaths.

An oncologist called the story "an irresponsible and provocative statement." That sentiment was echoed by a cardiologist who wrote, "Another irresponsible article is going to create more panic and mistrust of the medical profession. There are no data; mere suppositions and extrapolations of extrapolations. But once you launch a figure like 200,000 deaths, it will be impossible to cancel it from public opinion."

They were not the only readers who voiced concerns about the effect of wide dissemination of these findings on the public who may only read the attention-grabbing headlines. A neurosurgeon observed that "looking at four studies performed 5-13 years earlier and extrapolating to 2013 to claim that 251,454 deaths stem from medical error is not statistically sound. This type of fear-mongering is dangerous sensationalism." Another physician agreed. "Clearly, the study does not show causation. There is no way to prove that the errors led to deaths. Publishing this without real foundation will cause unnecessary panic."

Not all readers agreed that the findings of Makary and Daniel were invalid, and many were astonished at the reactions and comments made by their peers.

A pharmacist wrote:

It is appalling how cavalier many practitioners seem from their comments, instead of taking this deadly issue seriously. Grown men and women, with advanced medical and allied health degrees, are sniffing and discounting the reality of healthcare-induced harm when we all know it exists. Perhaps this study is not the Holy Grail, but don't kill the messenger just because you don't like the message.

A family physician concurred. "OK... let's really study this. Healthcare is far from perfect. Instead of getting angry and dismissing the study, we need to take a good, hard look."

A similar sentiment was expressed by another reader in response to the many comments from peers who dismissed the study out of hand. "One would hope that a study that exposes the high rate of medical error would generate a physician drive to investigate, confirm or deny the findings, and seek solutions. It is very disappointing to see an unwillingness to acknowledge a potentially serious problem."

A family physician recounted some personal experiences in support of the study's findings.

I recently sat at the bedside of friends who were hospitalized. It was a terrible, eye-opening experience. I saw equipment not working properly, arrhythmias and anoxia ignored, and delirium completely missed. I saw a large glass of juice given to a patient an hour before a surgical procedure, with the rationale that "It's OK because the patient's blood sugar is low." I saw incompatible medications being given together, with the justification that "If the patient goes into V-tach, it's OK; she's in the hospital." On and on it went. My friends are dead now. I just hope your loved ones don't end up in the hospital so you can see for yourself just how bad it can get.

Another physician commended the study for "directing attention to a part of the problem that really needs attention," but argued that it "fails to address the root causes of the problem of medical errors." A pediatrician who found the headline divisive also acknowledged that "the article opens a very important line of discussion and further study," adding, "I have no doubt that many deaths are due to clinician, nursing, and pharmacy error. Yet nowhere is it accounted for that the population as a whole is horribly sick from their own devices."

One family physician did not doubt Makary and Daniel's findings and believes the source to be the EHR:

"I hate to say it, but I see errors all the time. The amount of inaccurate information in the EHR is both astounding and frightening. Looking at hospital records the other day, I saw three different discharge doses of the same drug. I saw a patient with severe angioneurotic edema from an ACE inhibitor that was listed on the "continue these meds" discharge order. The EHR is overwhelming healthcare providers in the trenches with extraneous nonsense."

A family physician encourages reflection rather than fault-finding, saying, "As healthcare becomes more complex, the risk for error increases greatly. Physicians often overestimate the benefit of a treatment or test and underestimate the potential harm. This study should remind us to be better informed and more thoughtful."

And finally, this insight came from a pathologist: "To measure the present value of the healthcare system, we would need to know the death rate from no medical care."

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