The simple fact is that
medical errors are within the top ten leading causes of death in the U.S. That
said, consistent data is virtually impossible to gather.
The Institute of Medicine (IOM)
estimates that as many as 98,000 die annually due to medical error at a cost of
$29 billion. OIM also estimates that 15 million incidents
of medical harm occur annually. An
article in the Journal of
Patient Safety extrapolated the results of four different
studies to determine that between 210,000 and 440,000 patients who go to the
hospital experience some level of preventable harm that contributes to their
death. In just a few sentences I am able
to demonstrate that the variation in the estimates of medical harm make any
kind of concrete analysis nearly impossible.
The estimates also suggest that the number of medical errors is
astronomical.
Now consider the airline industry. The airline industry is heavily regulated and
monitored and concrete data is collected to include the fact that between the years of 2008 and 2012, 4,724 people were
killed in plane crashes. This is
approximately 945 deaths per year.
Compare this concrete data to the nebulous estimates related to
healthcare harm or death. The airline
industry data compared to the lowest estimates for health care (98,000) shows
that plane crashes account for 0.1% of avoidable deaths comparative to
healthcare errors. How is it acceptable
to have this kind of devastating error rate with an American public that
remains virtually unaware of and/or blissfully ambivalent to the magnitude of
the problem? Why is there little to no media
coverage when a healthy child dies during a routine tonsillectomy because the
anesthesiologist mistakenly injected epinephrine in to the direct line; thereby
irreparably damaging the child’s heart? This
is just one true story among thousands of examples that happen daily. And yet if a single plane goes down and 150
people die it is a national news event for days or even weeks with coverage of
every gruesome detail.
Obviously, part of the
problem is that concrete data is very hard to gather within the healthcare
field since it is across a multitude of health systems; both private and
public. There is no regulation or
requirement to nationally report on error rates and no standard level of
accountability has been established within the healthcare system. The very definitions of ‘medical error’ and
‘medical harm’ are nebulous and each health care entity can set its own
standards. Most relevant, is the fact
that most of the information is based on estimates which can almost seem sensational
instead of fact-based. It is
impossible to have a count that captures all of the times when patients
experience preventable medical harm.
This leaves us with approximations which are imperfect at best.
One area that is
compelling and receives a lot of attention within many professional articles
involves diagnostic errors. This also
was the topic of the article that inspired my blog post. Diagnostic errors include those in which the
patient is misdiagnosed, not diagnosed properly, or not diagnosed in a timely
fashion. Johns Hopkins researchers
report that diagnostic errors account for most claims, most patient harm and the
highest payouts. In 2013 a study was
done on 190 primary care physicians related to diagnostic error (exhibit 1). In 2010 the number of primary care physicians
was 209,000. This means the sample size
of 190 isn’t even 1% of the total number of primary care physicians which means
the statistical relevance of the data is nil.
The data was provided to demonstrate some common diagnostic errors that
are missed, why they are missed, and the harm that is caused. However, with such a small sample size the
results are meaningless other than as a starting point for a larger study. The data provided has inconsistency including
one total that adds up to 180%. In fact,
none of the percentages provided add up to 100% and no explanation was given as
to how the percentages were figured. It
is of interest that the most significant numbers for ‘what they miss’ are all
around 6%; this would indicate that the percentages are very small across a
broad range of diagnosis codes. It is unclear why these diagnoses were chosen over others. There
are also a multitude of unanswered questions that impact the results of this
type of study. How many visits did the
patients have and over what time period? What was the state of the patient panel in
relation to health; was there a high or low volume of acute or chronic
conditions? What were the patient
demographics? These are just a few of
the questions related to the human details and factors that would affect
results.
The article that spurred
my topic selection, as well as all of the supporting articles I referenced,
make it painfully clear that there is a serious problem collecting data. The irony is that the medical profession is
one of the most data-oriented and evidence-based professions. Being able to measure the incidence of
diagnostic error is essential if we really want the healthcare system to change. Until we are able to measure error and create
standard metrics that are enforced across all systems we will continue to see
an incredible amount of unnecessary and avoidable medical harm. Taking this one step further; eliminating medical
error would radically reduce the cost of medical care within our country. However, as demonstrated there is no good
data at this time. Without data there is
also no clear end in sight to the high cost of healthcare related to medical error. So far, the best we have is a
government program called Obama care for which the most prevalent outcomes include a
filibuster and a failing website.
My
advice based on the data is that if you are a healthy person and want to stay alive and medically
harm-free, avoid healthcare. How ironic is that?
Exhibit 1
– data as presented in article:
What They Miss
|
|
|
The Fallout
|
|
Pneumonia
|
6.7%
|
|
|
Potential Severity of injury from delayed or missed diagnosis:
|
|
Congestive Heart Failure
|
5.7%
|
|
|
Immediate or inevitable death
|
14%
|
Acute Kidney Failure
|
5.3%
|
|
|
Serious permanent damage
|
19%
|
Cancer
|
5.3%
|
|
|
Very serious harm, danger or permanent damage
|
16%
|
Urinary Tract Infection
|
4.8%
|
|
|
Considerable harm or remediation or treatment
|
38%
|
|
|
|
|
Minor harm or remediation or treatment
|
10%
|
|
|
|
|
Very minor harm or little or no remediation
|
2%
|
|
|
|
|
Inconvenience
|
1%
|
Why They Miss
|
|
|
No harm
|
2%
|
Ordering Diagnostic Tests
|
57%
|
|
|
|
|
History-taking
|
56%
|
|
|
|
|
Examination
|
47%
|
|
|
|
|
Referrals
|
20%
|
|
|
|
|
References:
Original Article:
The Wall Street Journal, ‘The Biggest Mistake Doctors
Make’, by Laura Landro, November 18, 2013
Wikipedia, Aviation Accidents & Incidents
http://en.wikipedia.org/wiki/Aviation_accidents_and_incidents
Shots Health News from NPR, ‘How Many
Die From Medical Mistakes in U.S. Hospitals?, by Marshall Allen, ProPublica,
September 20, 2013
http://www.npr.org/blogs/health/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals
