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Overestimating the effect of medical errors can be detrimental

Overestimating the effect of medical errors can be detrimental
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Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

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An issue with inflated numbers like 251,000 and 440,000 is that they are repeated by naïve journalists…

A musician’s cancer diagnosis could have been made 4 years sooner if a CT scan report of a suspicious lung nodule had been properly followed up.

I feel for the patient and agree that if the details of the story are accurate, he and his family deserve some compensation for the mistake.

However, the article on Philly.com contained this misleading statement. “His odyssey comes at a time when the health-care community is reckoning the full impact of medical error: In May, an analysis by Johns Hopkins University School of Medicine identified it as the third-leading cause of death in the nation, killing 251,000 people annually.”

That analysis, by Makary and Daniel in the BMJ, has been questioned by many including me. A post of mine explained why the number was likely inaccurate due to flaws in the authors’ methodology such as extrapolation of data from papers with only a few deaths, and like other studies in this genre, failure to explain how preventability was determined. As I have written, deciding that adverse events are preventable is extremely difficult.

In my post, I said, “about 715,000 people died in hospitals in 2010. Of those who died, 75% were age 65 and over, and 27% of in-hospital deaths were in patients 85 and over. The average age of patients who died in a hospital in the first decade of this century was 72 to 73.” The elderly often die of causes that are not preventable, and even if errors occur, they may not be responsible for patient deaths.

A thorough refutation of the Makary paper by Shojania and Dixon-Woods appeared as a response to the BMJ paper. Among other points they made was “the [251,000 patient deaths from medical error] estimate fails the plausibility test. Of around 2.5M deaths in the US each year, approximately 700,000 occur in hospital. We—and many clinicians and researchers—find it very hard to believe that one in 10 of all US deaths, or a third of inpatient deaths result from ‘medical error.’”

Shojania and Dixon-Woods were also critical of the extrapolation methods and cited papers which found much lower rates of preventable death. They suggested that the number of preventable deaths due to medical error was more like 25,200—10 times lower than the estimate by Makary and Daniel.

I and others similarly criticized the supposed 440,000 preventable deaths per year extrapolated by James in 2013. My review of that paper can be found here, and Anish Koka’s is here.

An issue with inflated numbers like 251,000 and 440,000 is that they are repeated by naïve journalists like the author of the Philly.com article and by people with agendas as demonstrated by this headline on RT, a Russian 24-hour English language news channel, “Medical errors kill hundreds of thousands each year in the US.

Even one medical error is too many.

But instead of helping to correct the problem, these exaggerated estimates serve only to 1) generate debate about the numbers, 2) deflect attention from how to solve the problem, 3) inflame an already skittish public, and 4) embolden groups like anti-vaccine advocates and “natural healers” who see mainstream medicine as evil incarnate.

 

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

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