What if the cure was indeed deadlier than the disease? A new analysis published in the Journal of Patient Safety suggests that as many as 440,000 hospital patients die each year from preventable harm.
In 1999 the prestigious Institute of Medicine (IOM) shocked the world of medicine with a report titled “To Err Is Human.” The researchers announced that as many as 98,000 U.S. citizens died each year in hospitals because of mistakes. The headlines were horrifying and the American public was outraged.
At first there was denial. Many hospital administrators and health care providers insisted that it couldn’t be true. There was a great deal of agonizing, hand wringing and buck passing. Eventually there was brainstorming on ways to improve patient safety. But nothing really changed.
Then came another bombshell. In 2004 an independent health care ratings organization (HealthGrades) determined that the initial IOM report grossly underestimated the number of preventable adverse events (PAEs). These investigators determined that instead of about 100,000 deaths annually, the real number was twice as high–closer to 200,000 preventable medical errors in hospitals that led to death.
Five years later in 2009 another investigative report titled “Dead by Mistake” also estimated that 200,000 Americans died annually from hospital acquired infections and preventable medical errors.
Now, four years after that report, we have a new scientific review published in The Journal of Patient Safety (September, 2013). The investigator utilized a much more rigorous technique for tracking mistakes called the Global Trigger Tool (GTT). Instead of relying on voluntary reporting by doctors, nurses and hospital administrators, the GTT flags errors in medical records that might otherwise be overlooked or ignored. The new study reveals a four-fold greater death rate in hospitals:
“…the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year.”
This makes medical mistakes in hospitals the third leading cause of death in America, right after heart attacks and cancer. But wait, it’s worse than that…far worse! This is just in hospitals. It doesn’t take into account mistakes in outpatient surgical centers where much of the surgery now occurs in this country. It doesn’t take into account mistakes in nursing homes and retirement communities where there is far less oversight. And it does not take into account clinics and outpatient doctors’ offices where misdiagnosis and medical mistakes may be more common than in hospitals where there is greater oversight and scrutiny by numerous health care providers.
If we add fatal adverse drug events in nursing homes (93,000), fatal drug events in the outpatient setting (roughly 200,000) and other health care harm in the ambulatory care setting, the total number of deaths attributable to treatment could exceed 800,000, making it the number one cause of death in America.
That is mind boggling. A spokesman for the American Hospital Association, not surprisingly, prefers the old 1999 number of 98,000 deaths. The reality is that no one knows how many people die in the U.S. each year from health care harm because there is no mandatory reporting system. Unlike in the airline industry, where pilots must report near misses and airplane accidents make the nightly news, medical mistakes disappear without a trace. The author of the new report came to the following conclusions:
“There was much debate after the IOM report about the accuracy of its estimates. In a sense, it does not matter whether the deaths of 100,000, 200,000 or 400,000 Americans each year are associated with PAEs in hospitals. Any of the estimates demands assertive action on the part of providers, legislators, and people who will one day become patients. Yet, the action and progress on patient safety is frustratingly slow; however, one must hope that the present, evidence-based estimate of 400,000+ deaths per year will foster an outcry for overdue changes and increased vigilance in medical care to address the problem of harm to patients who come to a hospital seeking only to be healed.”
Do not hold your breath. Since 1999 there has been precious little progress in improving patient safety. That is partly because it has not been a priority of American medicine. There is no National Institute of Patient Safety. Billions are spent on treating heart disease and cancer, but very little is devoted to helping doctors avoid misdiagnosis or mistreatment.
No one thinks they will experience a medical mistake. And yet a recent study suggests that misdiagnosis is common. If you are misdiagnosed, the recommended treatment is unlikely to do you any good. It might even cause harm.
The trouble is that such large numbers are not meaningful. Most people trust their doctor, their pharmacist or their hospital. They do not believe anything bad will ever happen to them or those they love…until it does. It takes personal stories to make this national tragedy understandable. Here are just a few.
“My father died as a result of a missed diagnosis. He was in the coronary intensive care unit at a teaching hospital after suffering a heart attack. He was treated first at a community hospital, then transferred to the teaching hospital for angiography. While waiting for the cardiac surgeon to review the test results, and while on anticoagulants, my father developed knee swelling and pain in the leg used for the angiography. He was treated for days with narcotic painkillers for sciatica, which only made him constipated.
“No one noticed that he was bleeding massively into his abdomen. Lab results demonstrating the blood loss were ignored. Six days after the angiogram, while straining on a bedside commode, he had another cardiac event. Hours later an attending physician finally saw the lab evidence of massive blood loss and ordered blood transfusions. Inexplicably, my father did not get the transfusion until many hours later after his heart muscle was irretrievably damaged. He went into cardiac arrest and died the day before he had been scheduled to go home.
“How do I know all this? Because I am a physician, I requested the chart. The nurses’ notes and lab results told the real story. Most families will never find out about diagnostic errors. They have no way to learn the truth.”
Here is another report:
“It is essential that patients take a proactive role when interacting with their doctors, especially when it comes to medications. Here is my story.
“As soon as my doctor walked into the exam room I let him know about my bladder infection. He immediately started writing a prescription for me.
“I asked, ‘what medicine are you prescribing?’ Without even looking up from his clip board, he paused, said, ‘uh, ah uh, Nitro-bid.’ I said, ‘Oh, that sounds like heart medication with the word Nitro.’ Again Not looking up, he just mumbled, ‘huh, uh no.’
“So I took the prescription, got it filled & took it for 6 days. I had a migraine headache for 6 days!
“I went back to the clinic almost a month later to say I’ve still got the bladder infection. The nurse pulled my chart. She then shifted her weight & blurted out, ‘Why did he give you heart medication!?’ I said, ‘I asked him!…’
“He was gone on a month’s vacation. She told me what day & time to call back & she’d put me through to him to tell him. When I called back I asked him, ‘How was your vacation? It’s good that you had time with your family.’ Then I told him about the prescription.
“There was dead silence; no ‘oops, OMGosh or sorry’ from him…so I said to him, ‘Wow, wouldn’t that have sucked to have come back from a nice, relaxing family vacation to find out that you killed one of your patients?’
“He mumbled, mumbled, mumbled…’uugghh’!
“Needless to say, I’m more proactive with my health care & especially prescriptions. I thank God for the health professionals in this world, but they are only human and mistakes can happen. If we’re proactive while showing respect to our caretakers…we can work together with them for our active health care.”
We too have experienced misdiagnoses and medical mistakes. A series of errors led to the death of someone we loved. That is why we wrote the book, Top Screwups Doctors Make and How to Avoid Them. We do not want anyone else to become a statistic. You will discover crucial questions to ask and tips to avoid screw-ups in hospitals, pharmacies and in doctors’ offices.
Everyone will be a patient sometime. If you care about your cholesterol, your blood pressure or your blood sugar levels, you should care about avoiding the leading cause of death in America, health care harm. We hope our book will help. Here is a link to learn more. Share your own story in the comment section below.