Ever since the publication of the infamous 2016 BMJ opinion piece by Makary claiming medical error should be considered the third leading cause of death in the US, the debate on the true incidence of deaths caused by medical error has been raging. Many, including me, felt the Makary estimate of 251,000 deaths per year from medical error was grossly inflated. For example, Makary extrapolated the number of deaths from three outdated studies with a total of just 35 deaths, and medical error was not well-defined.
A new paper in BMJ Open Access by investigators from the UK looked at 70 studies involving 337,025 patients mostly treated in general hospitals. Of that total, 47,148 suffered harm with 25,977 (55%) of harms judged as preventable.
The authors concluded “The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death.” I’ll do the math; 12% of 6% is 0.72% or just over 2400 preventable severe harms and deaths.
A recent literature review on the website Healthy Debate Canada cited three papers estimating incidence of preventable deaths due to medical error ranged from less than 1% to 5.2% and said “This would correspond to 15,000-35,000 deaths per year in the US, an order of magnitude lower than the BMJ estimate.”
Even one preventable death is too many. However, inflated figures like 251,000 deaths or even 440,000, as a 2013 paper claimed, undermine public confidence in medical care.
Some examples. The Canadian authors said calling medical error “the third leading cause of death” in the US enabled supporters of the NRA to say doctors are more harmful than guns. Naturopaths and alternative news sites warned about the dangers of our health system. I blogged about an article from RT, the English language Russian “news” website, headlined “Medical errors kill hundreds of thousands each year in the US.”
From Healthy Debate: “In-hospital deaths from medical error are a small subset of all medical errors, and non-fatal errors cause considerable harm to patients. Considering that most of health care occurs in the ambulatory setting, there is an even larger potential for error to cause harm outside of hospitals.” Focusing too much on in-hospital deaths from error may direct attention away from other areas of quality improvement.
Medical error is not the third leading cause of death in the US. Will people stop saying it is? I doubt it. A 2018 paper published in Science looked at 126,000 story links tweeted by 3 million people and found “falsehoods were 70% more likely to be retweeted than the truth.”
Suggested Reading:
The controversy around estimating deaths from medical error. Link.
Prevalence, severity, and nature of preventable patient harm across medical care settings. Link
“Medical errors kill hundreds of thousands each year in the US.” Link
Estimating deaths due to medical air: the ongoing controversy and why it matters. Link.
Are there really 250,000 preventable deaths per year in US hospitals? Link.
More proof medical error is not the third leading cause of death. Link.
Deciding whether adverse advents are preventable or not. Link.
Medical errors and deaths: Is the problem getting worse? Link.
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 9 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,700,000 page views, and he has over 21,000 followers on Twitter.
SkepticalScalpel
Abuse is another big coverup. As a retired nurse, I had no unrealistic expectations of a short stay for a right shoulder replacement since the left went so well. Big difference in hospital facilities. To keep this short:
Methodist Hospital in Minneapolis had an abusive late shift nurse that grabbed my jaw, reached 2 fingers down my throat to check for approved supplements brought from home. I demanded my clothes to go home. It would have stopped there but the room filled with 12 staff members and 3 security guards. My right to leave was denied when I was forced into bed, 4-pt. restrained AND TASED by the security guard. This took place while I, an 80 year old, 5 ft. female was totally naked and denied cover to my body. IT WOULD HAVE BEEN EASY FOR ME TO HAVE DIED FROM THIS EXPERIENCE AND IT WOULD HAVE BEEN EXPLAINED PERHAPS AS A FALL. I still suffer from this experience. It damaged my diaphgram, displaced my right hip, messed up the plate in my back, dislocated the new shoulder and now I have extreme back issues. What is sad is Methodist refuses to do anything about it. The abusive nurse still has a license and I am left on my own.
I can say that my father was in and out of the hospital my whole life. He died in 2000. He died because he was treated with a drug that had terrible interactions with his other drugs he was on because of kidney failure. A secondary dr prescribed the drug while his primary doctor was on vacation. Years earlier he was dying and was being treated for a heart attack when he was suffering a blood clot in the leg. A doctor just arrived to work, a thoracic surgeon, and saved the day. He lost his toes and almost his whole leg if he would have taken the advice of the original doctor that almost killed him. We just waiting for his leg to heal instead of amputation and that was all. The surgeon who saved his life later in my life took out a benign Teratoma. He was considered the best surgeon from Harvard medical school in Oklahoma at the time. Don’t trust doctors and don’t trust the system. We never let my father alone because they would do simple things to let patients sit in piss or excrement to worse forgetting to check on them or forget to give meds. I lived 25 some years and all I can say is you need to find that one doctor and then always what he when they are in the hospital. My father was a judge and an attorney, not that it matters but he was driven. Even back in the 80s his best friend who was a gastroenterologist always got him out of the hospital as fast as he could because even he said they will kill you.
Did I miss something? Both sides seem to be using hospitalized patients as the denominator. Medical errors causing deaths can occur outside the hospital as well.
in the U.S., there were over 35.5 million hospital overnight stays in 2018. (Summary Health Statistics: National Health Interview Survey, 2018) At the 0.0072% death rate you calculate above, that comes to 255,000 deaths.
I’m glad you did the math – unfortunately, you didn’t do it enough. You failed to multiply your death rate by the total number of U.S. hospital overnight admissions. The 2400 deaths that you list in your column may be from a limited study in the UK, and that number is completely irrelevant to your point about trying to prove that the number of iatrogenic deaths in the U.S is inflated. So why do I calculate 255,000 deaths using your own % death rate? You seem to have sloughed the total U.S. death off based on your irrelevant 2400 deaths.
You take Makary to task for extrapolating his number of deaths from just 35 deaths. Then you go to your 2400 death calculation based on including a few more people, and you seem to believe that’s the end. Where are the hospital patients in the U.S. in your calculatio?. I don’t see them anywhere. Enlighten me please.
nonsense…
all in order to continue to belittle the medical profession and control us…how low we have gone…I have not gotten a pay raise in years…
We have allowed our independence to be taken away, we have almost no say in what happens in our practice…
sadly many of us are just too ignorant, brainwashed to believe otherwise..
As a primary care physician for more than 20 years, I have observed an uncomfortable amount of medical errors occurring in hospital settings, during patient transitions, as outpatients and in nursing homes; not all fatalities but quite serious nonetheless.
The paper, even if an over-extrapolation on the exact number of deaths, has led to more vigilance from both physicians, hospitals and patients, but we have a long way to go.
I advise my patients not to have blind faith in physicians, including myself. No news does not necessarily mean good news with regard to test results and I advise all patients to call within 10 days and to get copies of all of their results. I advise patients to run their own medication interaction analysis every time a physician adds a medication. I advise patients to ask what their vital signs are before they are discharged (had a post-surgical patient discharged with temp of 101.9 and O2 Sat 92 readmitted with PE) and to carefully review discharge instructions so that they can ask questions.
In an ideal world, all patients would not only have medical advocates, but would have access to a national, accredited website containing detailed information about medical conditions, expected standard of care, medication interaction analyzer, prevention guidelines, how to read a blood test and have an associated app so that patients can actually accrue points for ‘learning’. Right now patients are scolded for referring to Dr. Google, but we offer them no alternative other than navigating the expensive, fragmented medical system.
Don’t you think it would be more useful to focus on how we can reduce medical errors rather than worrying about the optics of this research paper?
You make some good points. However, why can’t we do both?
Only wish there were more Dr’s like you!
You are absolutely right -in most cases, being well-researched & having questions form your doctor is not received well, and usually met with a borderline rude, defensive attitude/response.
As if almost to shame and discourage you from doing again in the future.
Which of course with me, never works. 🙂
Me inquiring about vaccines/vaccine injury used to embarrass my Kids.
Specifically, re: HPV vac, all of their friends’ parents just went ahead & did what the doctor told them too.
“Mom, come on. You’re not a doctor.”
That is until after 8 years, when I forwarded all the associated links to Gardisil deaths/injuries.
Now, mom’s a HERO.
Thanks for supporting self-education.
I just hope the path we seem to headed on with censorship takes an abrupt turn or best, is completely halted.
Have no idea what we’d do without free/open access to this kind of information.
I believe that there are errors covered up so that some deaths/adverse effects are not truly classified as preventable. I am a nurse and was a patient with an adverse effect after a lap chole. To make a long story short was in the hospital for 9 days after surgery, home for approximately 8 hours, back to ER then ICU for 5 days and then the floor for another 5 days.
I am sorry that you had a bad experience. I hope you have fully recovered. In most hospitals, a 9-day stay after a lap chole and an unplanned readmission 8 hours after discharge would have been investigated and properly categorized if errors had occurred. I suggest you ask the hospital’s ombudsman or risk management department for the results of that investigation. Please let me know what you find out. Good luck.