Every week, I receive unsolicited mail, asking me to donate money to some medical charity or another. My generous donation, I’m assured, will result in breakthroughs that will help prevent needless deaths from our nation’s biggest killers: heart disease, cancer, stroke, diabetes… Oddly enough, I’ve never received a letter asking me to help fund research into the third leading cause of death in the US, and quite possibly here in Australia too: medical error.
A new study published in the British Medical Journal (BMJ), one of the most prestigious medical journals in the world, set out to quantify the number of deaths caused in US hospitals each year by medical error, which is defined as
“an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient.”
The authors’ shocking finding, after examining hospital records, was that over 250 000 medical error-related deaths occur in American hospitals every year. That’s nearly 690 people dying every single day in US hospitals because they suffered adverse reactions to prescribed medication, were given the wrong medication, were injured during a diagnostic procedure (see the tragic case study below) or during surgery, weren’t given the appropriate treatment for their condition, or some other failure of individual doctors or the hospital system. This puts medical error in 3rd place on the cause-of-death leader-board, with only heart disease and cancer out in front.
The two scariest things about the recently-published paper are
1. The authors acknowledge that they have underestimated the number of lives lost due to medical error because they only had access to data regarding deaths in hospital:
“none of the studies captured deaths outside inpatient care—those resulting from errors in care at home or in nursing homes and in outpatient care such as ambulatory surgery centers”
and
2. None of the patient’s death certificates actually listed medical error as the cause of death. The doctor who fills out a death certificate must use an International Classification of Disease (ICD) code to describe the cause of death, and there is no ICD code for medical error. Doctors really do get to bury their mistakes.
My Dad was a flight engineer for Qantas, back in the days when airliners didn’t virtually fly themselves. Even after his retirement, aviation remained a lifelong passion for him; he obtained his commercial pilot’s licence, and had nearly finished building a kit plane in our back yard when he died – partly due to medical error, as I subsequently discovered.
He was administered nitroglycerin for angina after experiencing a heart attack during investigation for gall bladder disease. He was a poorly-controlled type 2 diabetic, and when diabetics are administered nitroglycerin their blood becomes abnormally thick, sticky and prone to clotting. This increase in platelet aggregability and blood viscosity is highly likely to have contributed to the second heart attack which ended my Dad’s life, while he was in the coronary care unit.
As the daughter of a man with Avgas in his blood, I can’t help but contrast the aviation industry’s approach to safety with the medical industry’s approach. When a plane crash (“accident”) – or even a ‘near miss’ (“incident”) occurs – it is immediately and thoroughly investigated by the relevant aviation safety body in order to ascertain the cause of the accident or incident. A report is then issued with recommendations for preventing a recurrence, and these recommendations are implemented across the entire aviation sector.
The aviation industry’s frank acknowledgement that flying is an inherently dangerous thing to do, and their attention to safety, has resulted in flying being, quite paradoxically, one of the safest activities you can engage in! The average person’s odds of dying in a plane crash are a staggeringly low 1 in 96 566, compared to 1 in 112 for dying in a car accident, and 1 in 234 for overdosing on prescription painkillers.
Provided by the National Safety Council
Cutting into a living human being, or administering drugs that alter body functions, is also an inherently dangerous thing to do, but the lack of a means to officially classify a death as due to medical error is a major handicap to implementing the kinds of measures that have made flying safe. Imagine the outcry if plane crashes caused 690 deaths every single day of the year. The media, politicians and the public would demand improved pilot training, aircraft maintenance, air traffic control systems and all manner of other safety measures. Yet all are strangely silent on the carnage caused by medical error.
The first measure that the authors of the BMJ article propose to reduce deaths due to medical error is to “make errors more visible”, and they suggest adding an extra field to death certificates so that preventable complications stemming from medical care can be listed as a contributing factor. They also advocate that hospitals “carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of error”.
Good luck with that one. I had to apply under Freedom of Information legislation to obtain my Dad’s medical records. Nowhere in these records was it acknowledged that administering nitroglycerin may have contributed to his death, and no investigation was undertaken by the hospital.
So how can you protect yourself and your family against medical error? Firstly, minimise your engagement with what Dr John McDougall calls ‘the medical mill”. Skip the annual check-up; avoid screening tests except for those that have been proven to save lives, such as the Pap smear; avoid taking prescription drugs except when there is no non-drug option available and the benefits of the drug very clearly outweigh its risks; only undergo medical investigations that are truly necessary; and aim to keep yourself out of hospitals, which are extremely dangerous places to be!
If you really can’t avoid going to hospital, take heed of Dr Robert Mendelsohn’s advice:
“A hospital is like a war. You should try your best to stay out of it. And if you get into it you should take along as many allies as possible and get out as soon as you can.” (from Confessions of a Medical Heretic)
Make sure you have someone with you who can advocate on your behalf. They, or you, should ask to see the package insert or equivalent for every medication given to you; question the necessity of every diagnostic procedure that’s recommended and ask if there are better and safer alternatives; request second opinions on your treatment plan; and generally make it known that you are are a force to be reckoned with.
Don’t be afraid to be the ‘squeaky wheel’; your aim is to get out of hospital unscathed, not to make friends with the staff. My husband always lets doctors know he’s a lawyer by profession – it brings almost immediate relief from symptoms of medical arrogance ;-).
And for god’s sake, don’t eat hospital food. It would make a well person sick; it can’t possibly help a sick person get well. Ask friends and family to bring you healthy, nutritious food like fresh fruit, green smoothies and soups to keep your nutrient intake high while you’re in hospital.
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