Tuesday, February 25, 2014

"Medical errors kill hundreds of thousands each year in the US"

How about that headline?

It appeared on RT.com, "the first Russian 24/7 English-language news channel which brings the Russian view on global news."

The story, which originally ran in November of 2013, was resurrected again on Twitter yesterday. It's subject was a paper that claimed as many as 440,000 patients die from medical errors in the United States every year.

Back in September, I criticized the study because it assumed that every death was both preventable and caused by a medical error. Neither assumption is correct. It also extrapolated the doomsday figures from only four other papers describing just 38 deaths.

In that post I said, "Inflating the incidence of these problems does nothing but further erode the already shaky confidence of the public in the medical profession. And creating the impression that such events are totally preventable leads to unrealistic expectations and unachievable goals."

So why am I bringing this up again?

Take a look at a few of the comments from the RT.com story [printed verbatim]:

Old news, as many as a million die each year cause of doctor errors. Thats why their malpractice insurance is so high. Legal unintentional homicide.

It's convenient to claim such deaths are errors but a great many are deliberate. They know such incidents will not be investigated as crimes. It's very easy to conceal a murder if no one is looking. The medical system is completely corrupt.

if they'd stop getting high in med school and pay more attention maybe this wouldnt happen. then there is their attitudes. Heaven forbid anyone needs medical care, that's for sure.

According to CDC, medical errors is not even a category of death, but they published research that indicates drunk drivers kill about 10,000 yearly. If that is correct, then doctors kill almost twice that many every hour of every day -. MADD should be mad about DEADLY DOCTORS. You are 40 times more likely to be killed by a deadly doc than you are by a drunk driver. And yet - where is the "funding" for this deadly phenomena?

I know those who comment on the Internet usually do not represent the views of rational individuals, but it infuriates the hell out of me that the 440,000 deaths from medical errors estimate, which is clearly wrong, is repeatedly trumpeted all over the place and so readily believed.

By the way, the paper appeared in the Journal of Patient Safety, which recently underwent an editorial change due to a kickback scandal involving former editor Dr. Charles Denham. That's another story (here).

Do doctors and hospitals make mistakes? Yes. Can we improve? Yes. Does it help to exaggerate the magnitude of the problem? Emphatically, no.


Diann Seigle said...

One in three hospitilizations results in an error - one in four an infection; It is not exaggerations that hospitals are deadly. We can improve but more importantly it is time to stop the deny and defend. Transparency around error is the only way for real learning to occur. The sentinal article "To Error is Human" put medical error as the 8th leading cause of death in the USA and we know it is actually much higher. Look at Rick Boothman's work at University of Mighigan teaching hospital to understand just how pervasive it is and what real leaders do to combat these horrifying statistics. Forty wrong site, wrong side surgeries a week in this country is not an exaggeration. Shame and blame does not work to change the culture we need honesty and learning to improve safety!

Skeptical Scalpel said...

Diann, thanks for commenting. Some of what you say is true, but do you have a link to a reference for your opening statement "One in three hospitalizations results in an error - one in four an infection"?

According to the AHA (http://www.aha.org/research/rc/stat-studies/fast-facts.shtml), there were 36 million hospital admissions in the US in 2012. Were there really 9 million infections? I don't think so.

I've sat on several hospital infection control committees and have never seen anything approaching a 25% infection rate. A brief search yielded some 2002 data from the World Health Organization (http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf) saying infections occurred in 4.5% hospitalized patients in the US---substantially fewer than 1 in 4. Yes, it should be zero, but some infections can't be prevented. I strongly support all reasonable efforts to prevent infection.

artiger said...

Certainly we could do better. Are we that bad? I hate to be Clintonian about it, but some of this might depend on one's definition of a medical error. Wrong site surgery is definitely an error. A surgical complication is not.

Any of those internet experts that have no confidence in us are welcome to stay home and treat themselves.

RuggerMD said...

I'm afraid that most of the people who make the comments as you showed above or as Dianne has just done, do it really out of blatant dislike of the medical field and physicians.
certainly there is no data to back anything they say.

Libby said...

If doctors deliberately kill people in their care, well, I guess the doctors who have treated me didn't get the memo...even the idiot who forgot I was a living breathing organism with working synapses.

I'm with artiger...let the "internet experts" treat themselves. Wonder if would be like the aphorism: "there are no atheists in foxholes" and have them suddenly believing in your skill in keeping people alive.

Skeptical Scalpel said...

Artiger, to be fair, some complications are our fault and could be prevented.

Rugger, I am waiting for Diann to give me a link to support her comment about infections.

Libby, I have no problem with people who want to improve the state of medical care. I just want to keep it real.

Anonymous said...

Some appear to assume that "Medical Body Repair" is substantially the same as "Automobile Body Repair". But the medical body repair is considerably more complex than is automotive repair. Errors in automotive body repair aren't very often fatal, either. Fatal to either the human driver or to the automobile.

I agree that there is a great deal of room for improvement in hospital care and office care. I am sure that the number of treatment related deaths is in the thousands per year, but nowhere near millions or hundreds of thousands annually.

My big concern is the BIG MONEY issue where the vast majority of "Medical Wealth and Earnings" is not in the practicing MD, but in external businesses such as Insurance, Drugs, Medical Devices and Instruments and more. Much of the continuing education of practicing MD's is actually funded by these external corporation interests.

Wendy Hanawalt said...

Your complaint is not specific to medical reporting but reporting in general, and people need to be aware of it. Reporters nowadays are exceptionally sloppy in their research, often engaging in second-source research. So if they read it someplace, they assume it's been factually vetted and it's true, so they use it as a "source." But if the original source is incorrect, what you get is a string of incorrect sources and facts that take on the power of urban legend. I have seen this repeatedly in news stories--information which I KNOW to be false treated as fact, because the reporter read it somewhere. It's not going to change until that changes, but it would be good if people started using some good old common sense (as you did in your 9 million infections comment) and just stop blindly accepting "facts" that seem off.

Anonymous said...

Wendy, here is a nice summary of the process you described: https://xkcd.com/978/

Skeptical Scalpel said...

First anon, Thanks. Good points.

Wendy, I agree 100% with what you said and second anon has come up with a mechanism for the generation of false information.

Carvel tiekert said...

I personally have seen within my family a minimum of one error for each hospitalization. Most have been minor, and not worth pursuing except to note them for staff. I had an infected abdominal close requiring debridement and subsequent hernia, which we elected to tnot try to close due to its size. unfortunately I've also seen poor record keeping, fraud and lots of incompetence. We actually see less of these problems in the veterinary profession, I suspect often due to the lack of long chains of command.

Carvel Tiekert, DVM

Skeptical Scalpel said...

Carvel, thanks for commenting. It is possible that your wound infection was not the result of an error. Wound infections can occur even when everything is done correctly. I agree that there can be poor record keeping and incompetence. Fraud may also happen, but I don't think it is that common. At least I hope not.

artiger said...

I would add to Carvel's comment that veterinary medicine involves a lot less bureaucracy than human medicine.

Anonymous said...

How long does it take to add a comment? I wrote one about an hour ago, it still hasn't appeared.

Skeptical Scalpel said...

I am sorry. Your previous comment apparently did not come through. That has been happening occasionally. There's something wrong with the host site, Blogger. Please try it again.

Anonymous said...

I recently underwent a heart double-bypass procedure that, after six months, has apparently been completely successful. I had to be readmitted three times -- statistically an enormous risk of death "from all causes". Yes, I owe my surgeon and my anesthetist and their teams my life. BUT...while in the hospital I acquired an infection that could have killed me and required heavy antibiotics through a PIC Line for several weeks. I have had a runny nose since the day after I woke up and it has never lightened up for six months, I have to carry tissue around all the time, and no one seems to give a damn about it except me -- the PC phys just brushed it off as if I was lucky that's all that's wrong. Both the surgeon and the cardiologist, at different times, warned me, seriously, to get out of the hospital as soon as possible. Both said basically that "you don't want to be in a hospital, it isn't safe to be here". My only other hospital stay was many years ago, to remove a diseased gall bladder. Instead of going home in a few days as promised, they kept me for more than a week, taking x-rays every day, and no one, not one single doctor or nurse including the original surgeon, would ever tell me why I was kept in the hospital. Just generalities. This was one of the largest, most prestigious hospitals in all of California. I have not spoken to a single friend or family member who has had any better experience in hospital. Bad news, unexpected complications, infections, crappy communications and senseless routines all the order of the day regardless of the institution.

Carvel tiekert, DVM said...

Follow-up to the response from SS.

I didn't mean to implicate an error with my post surgical infection. They happen. With thousands of surgical procedures in my 50 years in veterinary medicine I seen some, though thankfully not many. It seems they are higher in human hospitals than in outpatient setups and that may just the severity of procedures, but cleanliness in a number of human hospitals I have been in is not the best. To me, the most important person in dealing with that problems is often the least regarded and the poorest paid. In a seven day stay once I was the only one that cleaned the bathroom or anything else in the room.

Carvel Tiekert, DVM

Skeptical Scalpel said...

Anon, sorry about your bad experiences in hospitals. I agree that you should have been told why you needed X-rays every day. I can't imagine why they were being done.

Carvel, thanks for clarifying. You shouldn't have had to clean your own room. Next time, speak to the nurse manager(a k a head nurse) or the hospital's patient ombudsman.

artiger said...

To the Anon just above Carvel--Pardon my cynicism, but by chance, did you happen to have a very well-paying health insurance policy? I don't know how many years ago your gall bladder surgery was, but if it was in the last 10-15 years, I can't for the life of me figure out why your surgeon would want you lingering around the hospital that long. If it was longer ago than that, then you must have had a positive wallet biopsy. I'm sorry to say that does happen, and the bigger places are probably more guilty of it than the smaller ones.

Skeptical Scalpel said...

Artiger and Anon, there is no financial gain for a surgeon to keep a patient in the hospital. We get paid by the operation, not the length of stay. This has been trues for way more than 10-15 years.

The surgeon also would not get any compensation for ordering unnecessary tests on a hospitalized patient.

Anonymous said...

Regarding the untold hundreds of thousands "murdered" in US hospitals every year -- someone forgot to report that much, if not most, of the disease that exists in the US is self-inflicted. Those patients would never have been in the hospital at all, but for their abuse of cigarettes/alcohol/drugs/soda pop/junk food/lazy boy recliners. When a patient chooses to destroy his/her own health, and is on dialysis and 15 meds and in/out of the hospital on a revolving door basis -- and then some nurse or doctor makes a little or big error in the patient's last days of life -- I would propose that we list the true cause of death as "SUICIDE."

Anonymous said...

Not only is there no financial incentive for a surgeon to keep a patient in the hospital longer than is necessary, most hospitals keep surgical data that includes each patient's length of stay in the hospital, complications, infections, and readmissions. Hospitals are very interested in these numbers as they factor into reimbursement. If a hospital bean counter, or even the head of the department, saw that a particular surgeon was keeping patients in the hospital longer than his or her counterparts or national standards, there would be a reckoning. If patients were being kept because of complications or infections, that would be a problem; if the extended admission was because the surgeon was too lazy, or too distracted, or too arrogant to discharge the patient, that would be a problem, as well. With the oversight that has been in place for the past 20 or more years, it is much more difficult to keep a patient admitted than it is to discharge him. Finally, yes - it is true - surgeons, especially, recognize that the longer the patient is in the hospital, the greater the risk of being exposed to bad germs. Hospitals, no matter how well maintained, and no matter how diligent the efforts of caregivers, are germy places, and because we fell in love with antibiotics and prescribed them indiscriminately, today's germs are especially virulent. Tricia, RN.

artiger said...

Scalpel, I should clarify. Of course the surgeon has no financial gain in keeping a patient around longer (believe me, I know that), but I meant on the part of the hospital and any other consultants who might be following a patient. Sometimes a patient might be admitted to someone else (like for chest pain), only to find out that the patient had cholelithiasis, for which a surgeon, maybe even GI gets consulted. The surgeon may come in a do a lap chole, but in the instance of the "positive wallet biopsy", other testing and procedures may get done before dismissal. I've seen that happen more than once. It tends to drive us surgeons crazy, as we don't want them hanging around one minute longer than necessary.

Skeptical Scalpel said...

Tricia RN, thanks for the excellent comments.

Artiger, your explanation clarifies things nicely.

Fat Bastardo said...

Click HereMedical Industry Steals More Than the Bankers and Kill More Than the Nazi Holocaust

Skeptical Scalpel said...

I decided to publish your comment in the interests of free speech, even though I am under no obligation to do so.

It's clear that you didn't read this post or the one I wrote about the alleged 440,000 deaths caused by "medical errors" back in September explaining why every complication is not necessarily due to a "medical error."

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