Pamela A. Popper, Ph.D., N.D.

Wellness Forum Health

According to an article in the British Medical Journal, medical error is the third leading cause of death in the U.S., after heart disease and cancer.[i] At this time, considerable funding is allocated to research on heart disease and cancer, but since medical error does not appear on the list, little research money is invested in exploring ways to prevent it. The authors note that these findings should change research and resource priorities.

This is not new information, and many experts, including T. Colin Campbell, Ph.D., have written about it, criticizing the Centers for Disease Control for not including medical error on its top 10 causes of death. One of the reasons for this omission is that death certificates, which are used for ranking causes of death and for setting public health priorities, do not include information about medical errors. International Classification of Disease codes are used, and medical error is not included as an option in this coding system. The system was designed to facilitate billing for services, not for collecting data on public health.

Medical error is defined as an unintended act (either of omission or commission), treatment that does not achieve its intended outcome, the failure of a planned action to be completed as intended, or the use of an incorrect plan for achieving a stated goal.

Based on data from four studies that analyzed medical death rates and hospital admission rates from 2013, the researchers determined that 9.5% of all deaths, or 251,454 deaths in 2013, were due to medical error. In 2013, there were 611,105 deaths from heart disease and 584,881 deaths from cancer.

For many years, the reported death rate from medical error came from an Institute of Medicine Report, which listed the incidence as considerably lower, at between 44,000 and 98,000 deaths per year. This report was highly criticized because it its conclusion was not based on primary research conducted by the IOM, and because analyses by other organizations like the Agency for Healthcare Quality and Research and the U.S. Department of Health and Human Services showed that the numbers were actually much higher. Some claim that even this most recent report is too low; one group estimates that medical error causes over 400,000 deaths per year.[ii]

Jim Rickert, M.D., agrees. He says that many errors take place in doctors’ offices and outpatient centers, and this study only included deaths from medical error in hospitals.

He says, “I think most people underestimate the risk of error when they seek medical care.”[iii]

The authors suggest several strategies for improving the situation which include making errors more visible, and discussing them openly. They say that discussions about medical errors are often held in confidential forums in order to avoid unwanted attention. They also suggest changing death certificates to include an additional field that would record preventable complications resulting from the patient’s care. And hospitals should conduct internal investigations of deaths in their facilities to identify those cases in which error was a factor. Implementation of these strategies would allow for data collection, an accurate assessment of the problem, and development of systems and practices that address the issue. These are all strategies that have been used by the airline industry for decades, and have been contributed to making air travel extraordinarily safe.

Dr. Rickert says that these ideas would result in public pressure to change. He says hospitals, doctors and other providers have no incentive to publicize their errors, so outside pressure is needed.

In the meantime, some words of advice. This information underscores the need for consumers to be educated so that they can make informed choices. As Dr. Rickert says, most people don’t think much about risk when interacting with the medical system. But there are risks, even when visiting a doctors’ office for annual exams. The danger is greater in a hospital setting due to the compromised health of the patients, the hospital environment (the risk of infection is high), the health-destroying meals that are served, and the fact that hospitalization usually involves more drugs and procedures. Hospitalized patients should have an advocate, or several advocates for an extended stay, to oversee all aspects of care. These advocates should look at tests, medications, medication interactions, and if possible, bring in health-promoting meals from outside the hospital. It is often said that hospitals are risky places for sick patients, and sick people in these institutions need healthy advocates to look out for them.

[i] Makary M, Daniel M. “Medical error—the third leading cause of death in the US.” BMJ 2016;353:i2139

[ii] Classen D, Resar R, Griffin F, et al. “Global “trigger tool” shows that adverse events in hospitals may be ten times greater than previously measured.” Health Affairs 2011;30:581-9

[iii] Marcia Frellick ?Medical Error Is Third Leading Cause of Death in US.” Medscape May 3, 2016