Wednesday, November 27, 2013

Do you know that you are risking your life when you go to the doctor?


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
 American Association for Justice, ‘Preventable Medical Errors – The Sixth Biggest Killer in America’ http://www.justice.org/cps/rde/justice/hs.xsl/8677.htm
 U.S. Department of Health and Social Services, Agency for Healthcare Research and Quality http://www.ahrq.gov/research/findings/factsheets/primary/pcwork1/index.html
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
 




No comments:

Post a Comment