Over 250,000 people die each year due to medical errors, according to a new study out of the Johns Hopkins University School of Medicine. That figure makes medical mistakes America’s third leading cause of death, surpassing chronic respiratory diseases, unintentional accidents and cerebrovascular conditions.
Medical Errors Cause 250,000 Annual Patient Deaths
To arrive at their number, which is staggering by any measure, researchers analyzed the results of four different studies that looked into medical death rates between 2000 and 2008. The study was published by the British Medical Journal in May 2016.
If the estimate accurately reflects reality, only two medical conditions outrank medical errors as causes of patient death: cancer and heart disease.
How we rank causes of death is no small matter, according to Dr. Martin Makary, the study’s lead author and a professor of surgery at Johns Hopkins. “Top-ranked causes of death as reported by the CDC,” Makary told his university’s health publication, “inform our country’s research funding and public health priorities.” Cancer and cardiovascular diseases receive top billing, along with inordinate amounts of funding, but medical errors – because their magnitude has not been appropriately quantified in the past – get far less attention. That means fewer public dollars and almost no solutions.
Blind Spot: Why We Don’t Count Medical Error Deaths
The US Centers for Disease Control is missing out on many of the fatalities caused by medical mistakes, according to Dr. Makary, a tireless advocate for patient safety. In fact, medical errors are systematically, albeit unintentionally, excluded from national health statistics.
As Makary notes, US doctors have used the International Classification of Diseases (ICD), a compendium of over 16,000 discrete medical conditions, to diagnose patients, complete death certificates and gather statistical data. Every disease is assigned a numerical code, and when one of those conditions leads to a patient’s death, the death certificate will be filled out with the appropriate numbers. For cases of renal failure, health professionals have a choice between fourteen different codes, from N17 to N19, depending on individual patient characteristics. Pregnancy and labor complications come under codes P00 to P04. You’ll find everything from breast cancer to acute rheumatic fever in the ICD – everything, that is, except for medical errors.
These medical codes, which serve as the connective tissue in our healthcare system, weren’t intended to form the basis of any statistical analysis. They’re billing codes, Makary says, numbers meant to “maximize billing for physician services.” Since no doctor gets paid to make a mistake, especially one that threatens the life of a patient, it’s only natural that no specific codes exist for physician errors. Human factors, like negligence, aren’t counted. Nor are problems that come down to issues with the US healthcare system as a whole, a system that Makary says has become increasingly fragmented in recent decades.
Repeating Failures Of The Past
The ICD was adopted in 1949, a time when few healthcare professionals understood the significant role medical errors play in patient mortality. Ignorance of the widespread problem pushed medical mistakes outside the purview of government statisticians. When mistakes lead to patient death, the mistakes disappear – at least where our national statistics are concerned.
There is a hint of the self-fulfilling prophecy in this equation. Because doctors failed to understand the true magnitude of medical errors, they omitted the mistakes from our national health statistics, leaving physicians no way to recognize the true magnitude. According to Dr. Makary and his colleagues at Johns Hopkins, if we accounted for actual medical error rates, the American healthcare system would be found responsible for up to 250,000 deaths every year.
Doctors Protest “Garbage” Study Results
The study’s stunning result, however, has its share of detractors. In numerous responses, doctors from across the country have criticized Makary’s findings, along with the study’s broad definition of “medical error,” as “garbage,” “bogus” and “absurd.”
To arrive at their number, the team from Johns Hopkins focused their search of medical records on any deaths that resulted “from the care [patients] receive rather than from the disease or injury that brings them to care.” As Laura A. Stokowski, Clinical Editor at Medscape, notes, this definition would embrace a wide range of incidents:
- unintended acts
- acts that do not achieve their intended outcome
- failures in the completion of a planned action
- using the wrong plan to achieve a desired outcome
- deviations from the appropriate process of care
Many physicians have accused Makary of adopting an overly-broad conceptualization of error, one that fails to distinguish between true mistakes and unavoidable complications. In one comment, an anesthesiologist pointed out that both hospital-acquired infections and pulmonary embolisms were treated as “medical errors,” even though these complications are often unavoidable in a complex medical setting.