Medical error is third biggest cause of death in the US, experts say

http://www.theguardian.com/society/2016/may/03/cause-of-death-united-states-medical-error

by lemming • 10 years ago

636 501 10 years ago

viraptor3• 10 years ago

Does anyone know the actual paper/study link? Pubmed knows nothing, researchgate has some interesting safety-related articles (https://www.researchgate.net/publication/301685868_Surgeon-L...) but nothing about errors/deaths that I could find.

NVM, it's here: http://www.bmj.com/content/353/bmj.i2139

amalag• 10 years ago

Just an anecdote: Our friend in New Orleans had his wife's second baby delivery. They went to the same hospital and doctor as the first normal delivery.

She was given the wrong medicine in the epidural. She went into a coma, the hospital flew her to a specialty hospital in Denver to recover. Almost a year later she is still paralyzed from the waist down. Her life is ruined, her husband has two babies to take care of and an infirm wife.

The amazing thing is that the state of Louisiana has a $500k limit on malpractice! (Set in the 1970's) Plus he will not get the full $500k. In spite of their clear error the hospital will not just settle out of court. Instead if they pay out through the court system they only have to pay $100k, the rest comes from the state patient compensation fund which has $900 million dollars stored up. So my friend will get $350k and medical care for his wife.

This is called keeping costs down in the state of Louisiana. And this was affirmed in 2012 by their supreme court.

pen2l• 10 years ago

A lot of errors do seem to be this type: wrong medicine being given. The error can originate from any step of the way (doctor ordering the wrong medicine, pharmacist failing to confirm medicine being given is good or not, the nurse mistaking it, the drug-dispensing machinery involved failing, etc.).

Do any HN users have thoughts on what sort of system could be put in place to minimize mistakes like this in the field?

progressive_dad• 10 years ago

There was a definitive study done that showed you can reduce malpractice mistakes by some insanely HUGE amount by changing 1 variable: Leave nurses alone while they're administering medicine. In the study they gave nurses "Do Not Distrub" vests where doctors (no matter how important or urgent) may not disturb the nurses while they are wearing them. Can't find the original study but here is a related piece on hospitals initiating the practice with related resources:

https://www.amsn.org/practice-resources/care-term-reference/...

flarg7• 10 years ago

I am a former pharmacist who has moved into technology consulting. I'm in the UK so forgive the UK focus of my response.

It is in fact the role of a pharmacist to reduce medication errors - and this is achieved through a series of checks - largely focussed on asking 'is this the right medicine and dosage for this patient and the condition to be treated?' and 'has the correct medicine, dosage and dosage form been dispensed?'

Errors tended to occur outside of pharmacy's area of control; in theatres to where pharmacists often have little access, in ward settings where medicines are administered in sometimes noisy and chaotic environments, in clinical teams where pharmacists are not allowed to have a presence, and indeed in the modern NHS where pharmacy staffing levels are severely reduced.

A technological solution is possible - based on the concept of checklistbundles, patient medical and medication record systems and image scanning technology - but it is usually hard to sell clinicians on the idea of a check-list never mind anything else.

Until there is a true incentive to change practices around medication administration (i.e. unlimited fines) this will always be a hard thing to change.

Zigurd• 10 years ago

Checklists. It's been thoroughly studied. It works in other disciplines. I'm amazed the malpractice insurers don't write this into their policies: Checklists done or you're uninsurable.

estreeper• 10 years ago

To reduce this class of errors, perhaps RFID tags could be used? If the medication is prepared in a low-distraction area and tagged there, then the person administering the medicine would scan the tag to make sure it's correct before going through with it. The person tagging the medication could still make a mistake, but it would be harder for everyone else, and perhaps during the tagging process some kind of automatic flagging could be employed if the medication doesn't seem to match the patient's problems.

cmiles743• 10 years ago

Computerized order entry of medications. Poor penmanship and unreasonably unpleasant (or unreachable) physicians is still the root cause of many erroneous orders.

Even today, with the push for electronic systems, many physicians push the entry duty off on someone else thus keeping this kind of error alive.

jules• 10 years ago

Not taking medicine like epidural anaesthesia that isn't absolutely necessary would reduce the risk. I find the idea of spinal anaesthesia scary in general. It's poison with such a dose that it shuts essential parts of your nervous system down, but just under the dose that kills you. It's also in one of the most vulnerable places of your body, so that any mistake will likely have great consequences.

NotHereNotThere4• 10 years ago

I'm sorry for your friend, this is a terrible situation to be in.

And it's exactly why many people think pregnancies and births are over medicalized, especially in the US.

Women have given birth for a long time without medical intervention, using competent mid-wives, and now were at a point where every pregnant woman wants an epidural, a scheduled C-section (!!), inducing labor via medicine, etc. It's pretty insane..

The movie "Business of being born" (http://www.imdb.com/title/tt0995061/) goes into detail of how the mindset of handling pregnancies shifted over the last decade, and how pregnancies are almost a "disease" to be treated.

Edit: Since I'm getting downvoted for this, I simply wanted to correlate that more interventions = more risk. No other intent, and definitely not trying to "victim blame" given I have no knowledge of the specific situation above.

rayiner6• 10 years ago

Women have given birth for a long time without medical intervention

And they were dying in droves: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm (Figure 2); http://www.cdc.gov/mmwr/preview/mmwrhtml/00054602.htm (Figure 1).

Maternal mortality decreased from 700-800 deaths per 100k live births at the turn of the century to less than 30 in 1967, and 5-10 by 1996. Hospitalized births is one of the, if not the most astonishing triumph of modern medicine. It's bigger than the advances in cancer treatment and HIV put together.

snowwrestler2• 10 years ago

This is all correct, but might be rude in context. You have no idea if the epidural in the story above was medically necessary (many are), so replying with a post about voluntary procedures could be interpetted as subtle victim blaming.

My wife and I could not have done more to avoid medical interventions during the birth of our child, but the baby was facing the wrong way and an epidural was necessary to allow the midwife an opportunity to turn it. Thankfully the epidural was done properly.

pmarreck• 10 years ago

As usual, science and data should come to the rescue here, with the optimization goal of "mother and child both survive and are healthy post-birth"

Given that criteria, the current medical system seems to be doing OK, as others have stated.

If (for example) midwifing was superior, then the data would show that, period.

ksenzee2• 10 years ago

Personally I'd as soon have a root canal without anesthesia as give birth without an epidural. Modern medicine is a net good.

nommm-nommm5• 10 years ago

now were at a point where every pregnant woman wants an epidural, a scheduled C-section (!!), inducing labor via medicine.

This is so blatantly factually incorrect that it actually makes me sick to read.

I simply wanted to correlate that more interventions = more risk.

This is not always true and the maternal death rate shows that. I'll give you an example - I have a friend who had a scheduled C-section recently. She had a medical condition that made giving birth vaginally very risky from a health perspective. She could have been fine but there was a very large chance childbirth also could have triggered disability or death. She had a whole team of doctors coordinate with each other to choose the least risky option and they agreed that a scheduled C-section was best option for both maternal and fetal health. More intervention = much less risk in this case.

maxxxxx3• 10 years ago

The US needs a system where victims of malpractice get compensated but the doctors or hospitals are not necessarily held liable (unless it's gross negligence). US doctors spend a lot of time, energy and legal maneuvering denying and covering up mistakes instead of being able to admit them and improve procedures if necessary.

In my view there should be a nationwide malpractice insurance pool and the medical associations should push for better quality standards within their ranks.

wskinner2• 10 years ago

That seems like it would raise a serious issue of moral hazard.

cmiles743• 10 years ago

I don't see why the the anesthesiologist should not be held liable in this case (and possibly the hospital). In my opinion, it would be very reasonable for them both to pay a significant penalty.

These abnormally low (and capped) penalties make it easier for those who should not be doing this work to keep showing up every day. I understand that we don't want to scare people in health care out of the field, but those who are clearly inept certainly should be afraid to keep working.

tn134• 10 years ago

I think the above example illustrates why a malpractice insurance pool might be a bad idea. The one who makes the mistake must pay up. This will ensure those who make less mistakes will succeed at faster rate.

forgetsusername5• 10 years ago

In my view there should be a nationwide malpractice insurance pool and the medical associations should push for better quality standards within their ranks.

It's an interesting idea, but who pays for it? Taxpayers? Have fun with that politically. The doctors? You'll drive out those on the margins of "doctor or other career". We here in Canada already have a massive doctor shortage everywhere but major cities, so that's a problem.

Artistry121• 10 years ago

Can you provide evidence for this claim? I worked in doctors offices as a consultant for 18 months and never noticed doctors spending time "covering up mistakes". They did spend lots of time documenting their analysis and work though.

jpadkins• 10 years ago

how does the pool get funded? You can have some really perverse incentives depending on how its funded...

brownbat4• 10 years ago

the doctors or hospitals are not necessarily held liable (unless it's gross negligence)

I've had friends who have worked retained surgical instruments cases.

Meet one or two of those victims and you will never support tort reform again.

If this were a problem of gross negligence, then I would agree with you that we should focus there. But the problem isn't gross negligence, it's a problem of "business as usual." It's a thousand doctors following procedures with a 0.1% error rate and 999 thinking, "nothing bad's happened to me so I must be doing everything fine," even though they could each reduce that to a 0.001% error rate with a simple checklist or by actually washing their hands.

Put another way, if you put someone's life in your hands and you're not focusing a significant percentage of your efforts on procedures designed to radically reduce risk, then you're engaged in gross negligence.

There's another area where we all have that philosophy.

We send a million people hurtling through the air each day in incredibly complex machines. Airlines focus on safety because (a) they are actually responsible for their passengers and can't just call a mulligan because, hey, people make mistakes; and additionally, (b) they suffer massive reputational costs for safety errors.

So my medical malpractice reform would make medicine more like other industries with far better safety records. It would include a requirement that hospitals post their mistakes on their front door as people walk in.

dragonwriter7• 10 years ago

The US needs a system where victims of malpractice get compensated but the doctors or hospitals are not necessarily held liable (unless it's gross negligence).

Malpractice, by definition, is action falling below the standard of care set by the profession. If malpractice occurs, "improving procedures" is not necessary, because the harm results from failing to meet the the procedural norms of the profession.

Improving procedures is called for when adverse outcomes result from problems that are not malpractice.

neurotech15• 10 years ago

The problem is that most people don't realize that its relatively easy to for a patient (or their lawyer) to formally notify the state medical board of a complaint. Even billing issues are sometimes investigated by the state board.

For smaller claims, the doctor may settle the case for less than the threshold for listing in the public provider record. The National Practitioner Data Bank [0] is more strict in what gets recorded and doctors can't cover it up as easily.

Doctors and hospitals might try and deny the issue but in some states, if the complaint is substantiated (but the doctor is not formally reprimanded) it still gets noted in the National Practitioner Data Bank. This will be checked by any prospective employers in the future.

In aviation, there is a philosophy that its better to admit a mistake, and learn from it. This is known as the "Asoh Defense" [1]. Doctors could learn a lot from Capt. Asoh. The NASA Aviation Safety Reporting System [2] is for aviators to self-report a safety issue without fear of being violated by the FAA for their admission. There is even an immunity policy for non-deliberate pilot errors.

[0] https://en.wikipedia.org/wiki/National_Practitioner_Data_Ban...

[1] https://en.wikipedia.org/wiki/Japan_Airlines_Flight_2#The_.2...

[2] https://en.wikipedia.org/wiki/Aviation_Safety_Reporting_Syst...

adrianratnapala• 10 years ago

Not sure if there is a need for a national insurance pool or not -- but you are quite right. If the issue is getting procedures right, then insurers should have to pay up so they have an incentive to crack down on procedures.

However, I think the tort caps exist because when big bad insurance companies are involved, courts decide to play Santa and inflate damages to huge amounts. Caps are a crude way of getting around the problem though.

WalterBright2• 10 years ago

Punishing doctors for making human errors will not result in perfection. It will result in doctors hiding and denying their mistakes.

A better approach is to acknowledge that people will make mistakes, and work with doctors to identify why the mistakes are made and how procedures can be altered to prevent those mistakes in the future. This is how it is done in the aviation business. Punishment will not work.

cmdrfred3• 10 years ago

I wish I could just set an arbitrary cap on my liability. I'm sorry I totaled your car, here's 50 bucks.

dllthomas2• 10 years ago

Talk to your state senator...

forgetsusername5• 10 years ago

Provided nobody was hurt, your liability would be limited to the value of the car.

refurb2• 10 years ago

That's how it works in Canada. You keep the malpractice insurance rates low by limiting payouts.[1]

[1]In 1978, the Canadian Supreme Court limited damages for pain and suffering. Adjusted for inflation, the cap now is just over $300,000. The United States has no federal cap on damages, though a few states, including Florida, have imposed them.

LoSboccacc• 10 years ago

So you get five year worth of money for lifetime impairment? Sounds fair.

emodendroket4• 10 years ago

"Pain and suffering" is only one class of damages, though. What about the cost of medical procedures and lost wages?

Scoundreller5• 10 years ago

I'd argue malpractice insurance is kept low in Canada is through most MDs having the same insurance (CMPA), and only settling when fighting in court would be a guaranteed loss or set a problematic precedent.

As well, in Ontario, the government pays most of the insurance premiums:

http://www.health.gov.on.ca/en/pro/programs/ohip/mlp/announc...

tn134• 10 years ago

I am unable to why the state must pay compensation here. It should be the Hospital. It looks to me that State and Hospitals have colluded to create this $900M fund while reducing risk for Hospitals and not giving anything to the patients.

Can I have the link for SC affirmation ?

melling• 10 years ago

Shouldn't we be discussing ways to eliminate problems rather than increasing malpractice? What we want is for there to be a system where one person making a mistake is caught by enough redundancy. Maybe it's a cultural issue too? Remember the problem with pilots?

http://blogs.wsj.com/middleseat/2008/12/04/malcolm-gladwell-...

usaar333• 10 years ago

When my wife received an epidural, I noticed a warning label on the connector that said "Epidural, do not connect IV".

The only thing stopping such a horrible error is this label. IV and Epidural connectors are fully compatible even though they should never be used interchangeably.

I can only imagine how many other simple medical failsafes are missing.

pak2• 10 years ago

This is a very interesting little point, that consumer electronics (especially ports) have little physical safeguards to prevent errors—e.g., you can plug USB2 into USB3 for backward compatibility, but not vice versa, for the B plug; ungrounded extension cords try to prevent you from plugging in grounded plugs. Medical equipment generally doesn't do this. I think the problem is that there is a tradeoff between safeguards and allowing improvisation in a time of shortage or emergency; for example, I've seen blood draw lines repurposed as external irrigators (not as catheters) and that's totally safe as long as you dispose of the needle in a sharps bin.

mortenjorck• 10 years ago

Indeed, while the anesthesiologist was ultimately at fault, this story made me wonder about the design parameters around the mistake. Are the vials the same color? Do they have the same size and shape? Was this anesthesiologist near the end of a 16-hour shift and had to differentiate two very similar objects?

Your comment about the physically compatible, deadly-if-switched connectors was an eye opener: It's almost like if the USB standards group settled on a two-prong design that was physically compatible with a North American 110V AC outlet, and every USB cable shipped with a label saying "DO NOT PLUG INTO WALL OUTLETS".

jes• 10 years ago

I agree with you.

Poka-yoke, a technique from the Lean world, is useful here.

agumonkey2• 10 years ago

As a programmer with a slightly paranoid persona, I naturally spent countless hours thinking about 'non representable states' (my attachment for FP and formal systems wouldn't surprise anybody). And the same for real life situations, be it driving[2], or even more healthcare. Things that shouldn't happen shouldn't be possible unless clearly thought out and willingly carried out actions. I wonder how 'CS wishful thinking' this is, if this is a cultural problem. After all medicine is doing "ok"[1] without it, would it bring significant and stable benefits, at what cost ... Also we (whatever the country) should support this kind of effort way more, and pay and employ healthcare workers enough so they can work optimally. And governments should make it as easy and transparent as possible. The rest is ridiculously secondary.

[1] not diminishing what happened to people at all, but most of the time we're satisfied by medical approximations as much as we go on with our own mistakes.

[2] I'm all for self driving car studies increase, now that I've seen how people are taught and drive.

Pxtl• 10 years ago

My understanding is that most medical equipment is now designed to be incompatible for accidental hook-ups to the wrong thing. If the epi and IV aren't incompatible, there's somebody already working on making things that way..

knz• 10 years ago

At least they were able to recover some cost. My wife was nearly killed due to the negligence of an ER doctor during the pregnancy of my first child. Every doctor and nurse we dealt with could not understand how it happened and several told us that it was clear negligence but we were told by several lawyers that because there was no immediate and obvious long term harm we were unable to recover any of the additional costs associated with a six week stay in the ICU and hospital. We filed a complaint with the hospital in the hope that the doctor would at least be held professionally accountable but I'm skeptical that it amounted to anything. Pregnancy comes with some inherent risks but it's ridiculous that it's so hard to recover costs associated with gross negligence by an ER doctor (longer hospital stay, counselling for the trauma, related procedures because the doctor messed up so badly etc).

sjg007• 10 years ago

Since the care transferred across state lines can he make a federal case?

bduerst• 10 years ago

AFAIK, it's based on where the malpractice happened.

Plus, that would set a terrible precedence if one hospital couldn't airlift someone out to another hospital that could provide adequate care, because they were afraid of a federal case.

rms_returns2• 10 years ago

Can you please state the name of the hospital and the doctor? The least we can do is blacklist that hospital in our friend circles and defame it on FB, twitter, etc.

Dr_tldr• 10 years ago

Anytime someone talks about the need for tort reform and capping non-economic medical malpractice damages, this is what they're advocating for.

The idea that a "cap on damages" number could be found to cover lifetime expenses incurred for all malpractice cases would be difficult to swallow even if the number was backed up by a fairly large data-set. It's totally absurd when you consider that these numbers are usually arbitrarily set by uninformed politicians and highly biased lobbyists.

goodJobWalrus2• 10 years ago

Wow, I am about to have a baby any day now, this is scary. I really hope they are better in Canada with these things.

nugget2• 10 years ago

Do you know whether an anesthesiologist or CRNA provided the epidural? There's a huge push to replace MDs with nurses for anesthesia (to keep costs down) and I've heard of cases like this as a result. Like Nabisco shrinking a package of oreos from 6 cookies to 4 (for the same price) it's part of the slow dilution of service that we aren't supposed to notice.

Scoundreller5• 10 years ago

Is there evidence to suggest that CRNAs provide poorer care? Someone that is paid less or has less education does not automatically result in poorer outcomes.

ams61105• 10 years ago

As my brother the surgeon says, the last place you want to be when you're sick is in hospital.

peterwwillis• 10 years ago

I am very sorry for your friend's wife. That's.... it really really sucks.

It occurs to me that if all the medical malpractice deaths (250,000) were paid out at that cap ($500k), that would cost 125 billion dollars.

We don't have a lot of extra room in our budget right now, so that's going to be tough to pay out, even though it's not even enough. But clearly the even bigger problem is the 250,000 unnecessary dead people.

If we took a part of that money and used it to fund an agency that just works to fine-tune and eliminate medical malpractice deaths, that would save almost double the amount of people that die from guns and automobiles each year. But that wouldn't help your friend's wife, who didn't die.

What would have helped her would have been avoiding medicine that was not necessary, like the epidural. Of course it would have been an excruciating delivery that nobody should have to endure - but I think a risk assessment would conclude that the risk (death) is not worth the benefit (lack of pain). At the same time, having better drugs would also help, but we don't necessarily have that as an option today. So perhaps a campaign to avoid unnecessary medical procedures, and literature to help educate and give agency to those who would be going through those procedures, would be helpful.

peter303• 10 years ago

Colorados limit is $250K. Lawyers wont take a case unless it is slam dunk.

fencepost• 10 years ago

Replying since you don't have contact info...

If they had life insurance it may be worth looking at that policy as well - depending on the policy it may also cover disability or loss of (use of) limbs. Sounds like every little bit may help.

xahrepap• 10 years ago

Another anecdote: a close loved one lost their leg due to malpractice. Staff infection. He went in and told the doctor he thought he had an infection. The doctor said it was fine even after running other tests. He's has multiple doctors and nurses look at the test since and say that it's pretty obvious that he had an infection.

The greatest part? Their lawyer could not get any doctor to testify as an expert witness, which is required under Utah state law for malpractice (which makes sense, I suppose). Even if they could've, the lawsuit would've only covered $400k since it's capped. Which might've covered the doctor bills, but not the damages to his life... He was between jobs, then ended up in and out of the hospital for a couple years due to the infection getting out of control (lost his leg, had his shoulder replaced, physical therapy, ended up falling and having pretty sever damage and having to start over again). By the time he was on his feet again, he was worn out and past retirement age. Whose going to hire a "gimped old man"?

It was a mess. Still is... But things worked them selves out as best as possible. But it's incredible to me that that doctor is still practicing and possibly destroying other people's lives because no other doctor was willing to "out" a "colleague". Frustrating.

StanislavPetrov• 10 years ago

The amazing thing is that the state of Louisiana has a $500k limit on malpractice!

This is what politicians are referring to when they talk about "tort reform" (rather then the egregious legal nonsense they decry when trying to get it passed).

wolframarnold3• 10 years ago

It's heart-wrenching stories like these that prompted my wife and me to have our daughter at home. It was a beautiful birth. Birth is not a medical emergency, but hospital economic incentives are such that they're always trying to make it one.

et2o6• 10 years ago

The only reason it is no longer a medical emergency is because of modern medicine and hospitals. Women and children used to die frequently during childbirth.

WalterBright2• 10 years ago

One way to deal with the wrong drug problem is to use different colors and shapes of bottles to represent different categories and dangerousness of drugs. Coloring can be added to the drug itself, such as using a red for more toxic medications, and green for more benign ones. A deeper shade of the color can represent an increased concentration.

Just like different shapes and colors of wine bottles are used for different wine categories.

I saw a show once which traced a medicine overdose to the bottles for the different strengths of the same drug being identical. The doctor just picked up the wrong one.

jgrowl• 10 years ago

Another anecdote... My step sister went in to have a growth removed from her arm. Was just supposed to be a simple outpatient procedure. They put a cuff on her arm and injected lidocaine. Their first mistake was loosening up the cuff which shot lidocaine into her heart and stopped it. The second mistake was that no one noticed for 5 minutes. She was literally sitting there dead for 5 minutes. They somehow revived her but the had brain damage. She acts like a completely different person now. She got diagnosed as bipolar afterwards and the hospital claimed that she just always was like that. They offered a small amount that they ended up having to take it after a whole horrible legal process. It was like maybe 50k for completely disabling her. She has 4 kids, one disabled, and is too incompetent to take care of them. She lost them all. She now is off and on homeless after she started breaking all the windows in the house and lost her fiance because he couldn't take it anymore. She hordes trash and thinks she's going to be a famous singer. If I remember right, the anesthesiologist got in trouble for previously watching porn on his phone during procedures.

Fuxy• 10 years ago

This mechanism is completely broken considering medical care in the US is ridiculously expensive.

The hospital should be held responsible financially for the patient until she dies or their mistake gets fixed.

No lawsuit just a simple if you break it you own it philosophy so the hospital is responsible for the medical bill and any loss in financial earnings incurred because of their mistake payed monthly to the patient or its immediate family.

speby• 10 years ago

That is terrible, truly terrible. If given a blank slate to work with and dealt with all over again, what would be a better way of dealing with the liability? More monetary compensation? Or something else?

bradleyjg3• 10 years ago

If someone has terminal cancer, gets palliative surgery, the surgeon makes a medical error, and the patient dies on the table has he died of medical error or cancer?

For this reason deaths caused isn't the best metric. It would be better to use QALY (quality of life adjusted years).

nihonde• 10 years ago

If the error is a 'but-for' cause of death, then I think it ought to be counted. All treatments are aimed at addressing an underlying problem. Just because that problem is terminal doesn't change the fact that a mistake killed the patient. As someone who just watched up close a loved one die from cancer over a seven-year period, you really come to appreciate every minute that they're still breathing (with some allowance for the final, vegetative stages).

_yosefk• 10 years ago

It still matters if the error occurred when the life expectancy was 7 years or 7 months, so ideally you'd want to count that.

bryanlarsen• 10 years ago

The argument against counting it is that extremely risky surgeries are generally only performed when the patient is going to die otherwise. Those risky surgeries have a much higher rate of mistakes, but that's generally deemed acceptable, as long as that risk is properly communicated to the patient's family.

The doctors most commonly sued for malpractice are those doctors with poor communication skills rather than the doctors who make the most mistakes.

epoxyhockey• 10 years ago

the surgeon makes a medical error, and the patient dies on the table has he died of medical error or cancer?

Medical error. Just because the patient was going to die sooner than later, does not erase the fact that a medical error was committed.

Quality of life is a completely different topic, in my opinion, and I am sure we would find more common ground in that discussion.

jessriedel2• 10 years ago

Quality of life is a completely different topic, in my opinion, and I am sure we would find more common ground in that discussion.

You don't understand why bradleyjg brought up QALYs.

oconnor663• 10 years ago

On the one hand, I could see arguing that a surgeon's error is independent of the patient. To the extend that's true, it would be important to count errors whether or not the patient is close to death.

But on the other hand, maybe the surgeon is performing a risky, error-prone procedure precisely because the patient is close to death. To the extent that's true, it might be misleading to compare this surgeon's record with someone else's.

I wonder if some of the resistance we hear from doctors about measuring/enforcing these things, is because of difficulties like this that are obvious to them and really screw them over?

frozenport2• 10 years ago

If the motivation is to punish and stop bad doctors, then the QALY doesn't matter.

smileysteve6• 10 years ago

But, if measuring QALY, then, riskier procedures with great reward, can be promoted; which maybe they get better?

Unklejoe2• 10 years ago

An error is an error.

It would be different if the procedure was executed properly but the patient died anyway, but if the death is a result of an actual mistake by the doctor that could have been prevented, then it seems pretty straight forward.

Edit: I should add that the tricky part is deciding if the mistake could have been prevented, and if so, the level of negligence in play. Doctor was drunk during surgery? Easy. Doctor had a spasm during surgery? Harder to decide.

People aren't perfect, so I could see this causing many doctors to just avoid risky situations all together in fear of making a tiny mistake.

Johnny555• 10 years ago

It's not always clear-cut -- if the surgeon nicked an artery during surgery (and immediately repaired it) but the patient died during surgery, did he die due to medical mistake? The surgeon clearly made a mistake, but did it contribute to the death?

cmdrfred3• 10 years ago

If what you said is logical then is it not also logical that you should get a shorter sentence if you murder an older person, or the the victim was a smoker as opposed to not?

venomsnake5• 10 years ago

When my father was dying (liver cancer, he was goner, no surprises) a senior doctor in the hospital made one of the intern's life hell about not weighting the excreted urine when changing the bags.

The intern (and me) pointed out that it was pointless - his answer - "He is in our care, and if we do something, we do it right" - that is the attitude that saves lives.

A mistake is a mistake. It may even lose someone 15 minutes - doesn't matter - it was literally everything left that the patient had in the world. We are not talking about shit happens situations - there will always be risks when doing interventions.

bradleyjg3• 10 years ago

Suppose you are in charge of approving grants for a particular program. Presented to you are two applications:

One attacks medical errors. The grant application claims that it will prevent 10,000 deaths caused by medical error and the loss of 100,000 quality adjusted years of life.

The other attacks diabetes treatment non-compliance and the grant claims it will prevent 5,000 deaths caused by diabetes and the loss of 200,000 quality adjusted years of life.

All other things being equal, which one do you fund?

Alex3917• 10 years ago

For what it's worth, I have a lot of stats here that put this into context and also provide some good additional reading:

http://www.alexkrupp.com/Citevault.html#iatrogenic

(And yes, I know this could be made much more readable with some basic CSS, I'll get around to it eventually.)

DINKDINK• 10 years ago

Iatrogenics needs to be discussed more, thank you for your contribution regarding this topic

jobu• 10 years ago

Often the medical errors happen on very common procedures like central-line catheters or IV insertions. Staff are overworked and tired, or they get distracted and miss one step and it results in a patient blood infection and often death.

John's Hopkins came up with a five-step checklist for central-lines that reduced overall hospital deaths by 10% http://www.hopkinsmedicine.org/news/media/releases/safety_ch...

maxerickson4• 10 years ago

A key aspect of that checklist program was that nurses were empowered to make sure doctors followed the checklist. Doctors are resistant to adopting such programs.

https://en.wikipedia.org/wiki/Peter_Pronovost#Work

Eric_WVGG• 10 years ago

There’s a related bit regarding pilots and copilots. http://www.publicspeakingtoolkit.com/ethnic-theory-of-plane-...

(take w/ the usual Gladwell-grain-of-salt)

jdudek• 10 years ago

The story of this checklist has been covered in “The Checklist Manifesto” by Atul Gawande. It’s a great read on how diligence in work can literally save lives. We can advance medicine by breakthrough discoveries that push our knowledge further, but improving how we apply the existing knowledge is just as (or even more) important.

mariodiana3• 10 years ago

Gawande's essay (and book) on the subject came up just recently in discussion on Hacker News. What it all boils down to is that the medical profession in hierarchical and conservative: doctors don't want to change and don't want anybody telling them what to do.

flubert2• 10 years ago

Staff are overworked and tired

Yes, I wonder if anyone has studies the medical error rate as a function of how many hours the provider has worked previously that day, and the time of day. One thing I found crazy was that nurses were working three 12-hours shifts per week, but then there was overtime. This might be okay for a 7AM-7PM shift, but what about the 7PM-7AM shift? What if they changed to five 8 hour days instead? How would that effect the error rate?

cmdrfred3• 10 years ago

Also, if demand is so high that they need to work such hours why doesn't the nurses compensation reflect that? Shouldn't they all be making 300k a year?

jonwachob912• 10 years ago

Typically a nurse working 12 hour shifts will do 3 days one week and 4 days the next week.

The 7pm - 7am shift is actually EASIER then the day shift because a lot less happens. The patient is sleeping, the doctors are away, family is gone, and the test labs are closed. At that point the nurse has one job and one job only, keep the patient alive until morning (a hospitals real job is not to fix you, but to keep you alive. It's your primary's job to fix you).

Of course the ED plays by none of those rules :)

cloverich4• 10 years ago

The Catch-22 there is that a majority of medical errors occur during shift changeover. (Google will reveal an abundance of commentary / articles). In my personal experience (Medical school) the shift change's amongst Doctors could occasionally be profoundly short, unprofessional, and unregulated (think Resident handing off to Intern, in a rush, late in the evening, using a some notes hastily written on a notepad).

smileysteve6• 10 years ago

Hopefully, some of the studies showing that work detriments after 6-8 hours will spillover from select tech companies and academia to the broader market and other industries at some point.

haldujai2• 10 years ago

This is not a perfect study by any means but this was just done, it's known as the FIRST trial[1] and it looked at flexible vs standard surgical residency work hour restrictions. The conclusions were that work hour restrictions did not improve mortality or patient outcomes. There is a related study that is currently ongoing that looks at the same thing but in medical specialties.

1. http://www.nejm.org/doi/full/10.1056/NEJMoa1515724 2. http://www.nejm.org/doi/full/10.1056/NEJMe1516572

peckrob3• 10 years ago

It always surprises me when I learn that more industries haven't adopted standardized approaches like this. Using a checklist when doing anything that may have the chance to seriously injure or kill, like for many things in medicine, just seems like a really good idea to me. Even if it takes a couple extra minutes to run.

I'm a pilot in my spare time; every single thing we do usually has a checklist associated with it. Preflight cockpit, external and cabin, pre-engine start, engine start, pre-taxi, engine runup, pre-takeoff, takeoff, after takeoff climb, cruise, descent, before landing, base and final, after landing, shutdown and park. Every phase of a flight has a checklist associated with it. Emergencies or unusual situations also have their own checklists. Hell, even walking into many FBOs, there are signs reminding you to turn off your master switches and close your flight plans.

In training, it is drilled into new pilots to always, always follow the checklist to the letter. Because when we don't, we stand a good chance of missing something. In extreme cases (just like in medicine), just one missed item on a checklist can get you killed [0].

I've found this obsession with checklists seeping into other areas of my life. I have a 15-item checklist for leaving the house when I go out of town, for instance. And in software development, I have a 10-15 item checklist I always go through before rolling code to master (this has saved me countless embarrassments on the low side and potentially bringing the site down on the high side).

TL;DR checklists are good, and more people should use them.

[0] http://www.rapp.org/archives/2015/12/normalization-of-devian...

kevan2• 10 years ago

A fundamental difference between medicine and flight is motivation. When pilots screw up they die, when doctors screw up, someone else dies. Medicine idolizes heroes, a single doctor doing everything and saving the day. In air travel the heroes tend to die. The origin of the airline checklist is when Major Ployer P. Hill, one of the best test pilots in the Army, forgot to release the elevator lock on a B-17 prototype before takeoff and died as a result.

mavrc• 10 years ago

If I didn't know better I'd think you were CGPGrey. You're right, though, checklists do make things so much better, as long as you're not tied to the list. I would imagine (please correct me if I'm wrong) that pilots' checklists are developed over time by veterans and changed infrequently. If you're developing your own checklists, be prepared to modify them. Often. This is still better than the alternative, because you are now aware of problems or steps you should have included.

Checklists are also good for helping you start things, if you have trouble getting started with stuff. It might be a little weird, but I keep a list of fun things I want to do. And I don't mean just big things ("visit London"), I mean smaller stuff. I find that after busy weeks my (old) brain is tired and doesn't want to start a new task, even if it's a fun task, so it tends to fall into patterns like "eat popcorn and watch Netflix." But if I have a list that reminds me that I could read up a bit about that microcontroller project I want to work on, or that topic I wanted to write something about, it helps me get started.

matwood2• 10 years ago

When I had my ACL fixed, the nurse doing the IV asked if I was worried about the surgery. I told her the only thing I was worried about was catching some hospital bound staff infection or being given the wrong medicine while I was under. She seemed a bit taken back, since it was not about my knee (I had already done the "This leg!!!" in sharpie), or her currently sticking me with an IV.

She continued to chuckle a bit until she realized I was serious.

fokinsean• 10 years ago

Currently my reason for procrastinating on getting my wisdom teeth pulled. I freaked myself out by reading many stories of things going wrong. Ugh.

lbhnact• 10 years ago

Just FYI, many hospitals other than JH were doing this long before JH.

JH is actually on the traditional/conservative end of the healthcare spectrum when it comes to process/algo/checklist style care, for better or for worse.

rayiner6• 10 years ago

Estimates peg the cost of preventable medical errors at $100 billion-$1 trillion per year: http://www.wolterskluwerlb.com/health/resource-center/articl.... Applying the methodology of this article to the estimate (250,000 deaths per year) in the Guardian piece, yields an economic cost of death due to medical error of about $250 billion.

Ironically, the recent debate has centered on "defensive medicine" which posits that doctors are too careful because of malpractice claims. But the estimated costs of premature death due to medical error dwarf the estimated costs of defensive medicine, about $50 billion per year: http://medicaleconomics.modernmedicine.com/medical-economics.... In fact, the data suggests that doctors and hospitals are not careful enough.

maxerickson4• 10 years ago

Defensive medicine isn't just about being careful though, it's about ignoring the medical necessity/utility of tests and ordering them because they might be useful against a liability claim.

In the extreme, complications from tests ordered due to a defensive mindset could drive both costs.

I like this quote from Peter Pronovost, from the wikipedia article I linked in another comment:

The fundamental problem with the quality of American medicine is that we’ve failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is ensuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine.

snowwrestler2• 10 years ago

The question is whether the costs that lead to defensive medicine--specifically lawsuits and malpractice insurance to cover lawsuits--actually make doctors more careful.

In my limited experience, the medical professionals I know in private practice feel that exorbitant malpractice coverage costs force them to manage a higher volume of patients than they would prefer. Insurance is a fixed cost so they can make it up on volume. But that gives them less time with each patient, and puts more patient care into the hands of nurses, PAs, and residents.

Edit--should have said the costs that lead to defensive medicine

cloverich4• 10 years ago

"Defensive medicine" is a common defense but, in my limited personal experience I don't think it is valid. Doctors who know (and follow) the guidelines never seem to say anything about Defensive medicine; Doctor's who seemed to either not know them as well (or just not know what they were doing as well in general) were constantly bringing up defensive medicine complaints. Its also interesting to note the many of the tests you order come with an interpretation provided by another physician. So, a Doctor (esp. resident / intern) who is unsure of themselves will often order unnecessary tests as a way to consult with other Doctor's (it is, process wise, far too difficult to simply say "I don't know" and get help).

venomsnake5• 10 years ago

Defensive medicine is prescribing antibiotics for viral infection when the patient obviously does not need them, but he insists taking them to feel taken care of.

venomsnake5• 10 years ago

The thing is defensive medicine does not reduce errors. Or mortality. It even increases them - more procedures = more risks of complications. It is done for covering a doctor's ass, not the benefit of the patient.

You can prevent errors only with proper procedures.

jonwachob912• 10 years ago

So... No mention of the different errors that occur and lead to these deaths?

A quick look on the CDC site indicates about 70k a year deaths from infections acquired in the hospital (HAIs), but other very reputable sources point towards 100k deaths a year.

What medical error committed is not trivial, and should be listed. Not all procedures carry the same risk.

schizoidboy• 10 years ago

It would be fascinating to work towards reducing this problem. Any thoughts on how to get into this field or how software could be applied?

itg• 10 years ago

If we couldn't get surgeons to use a simple checklist procedure which was shown to reduce the number of errors, I don't know what will.

ashearer• 10 years ago

A major aspect is miscommunication. According to the Joint Commission: "Ineffective hand-off communication is recognized as a critical patient safety problem in health care; in fact, an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients." [1]

I co-founded Care Thread [2] to help address the communication problems I saw working in hospitals. Electronic medical records systems weren't designed around real-time communication, and mobile secure messaging systems tend to replicate the original alpha pager workflow, without directing the improved technology at improving collaboration.

The project involves removing points of communication friction, keeping track of the patient's care team, injecting relevant EMR data into the communications stream and pushing it to the right care team members as soon as it's available, and keeping everything visible to the interested parties.

If you're interested in something like this, I'd love to talk. Please contact me through my profile or on our web site.

[1] http://www.jointcommission.org/assets/1/6/tst_hoc_persp_08_1... [2] http://www.carethread.com

alon44• 10 years ago

Hi ashearer, I work with the Patient Safety Movement Foundation and just sent you an email through your demo@ email address. Looking forward to connecting with you.

good_sir_ant2• 10 years ago

Enabling free(er) competition into the medical marketplace for doctors would probably be the single most effective maneuver.

That and letting machines begin replacing human doctors...

Shivetya• 10 years ago

I learned this lesson through my boss who passed away awhile back after years of liver problems. If you want to survive complicate or life threatening health issues you need to learn as much as you can about what your treatment options are, which medicines are safe, at what dosage, and in what combinations.

My favorite story was his stopping a nurse from administering 700 units of a medicine that in that volume would have killed him. The doctor had written 200 but the bottom of the two landed on the line of the form near perfectly. Fortunately the nurse went to verify and he made it out that time

Unklejoe2• 10 years ago

It's amazing that prescriptions are still being hand written these days.

mariodiana3• 10 years ago

It's amazing that my bank asks me to write amounts both longhand and in numerals when writing a check, even in amounts as small as a dollar, but that doctors scribbling out dosages of medications that can easily kill people has been standard operating procedure since the whole thing started.

uslic0013• 10 years ago

Most hospitals now have computerized order entry now so they are not written by hand. Most prescriptions in private practice are also now computerized and sent electronically per federal mandates.

davidw• 10 years ago

How does this compare to other countries?

nxzero• 10 years ago

This isn't news, nor is the fact that people refuse to except that medical professionals are not prefect. Both the patient and medical communities are responsible for fixing the issue. Until that's the case, this will always be an issue.

shivpat• 10 years ago

This is a weak analysis.

"To determine the medical error death rate, the researchers analyzed data collected by the government and compared it with hospital admission rates from 2013. They extrapolated that information and found that 251,454 deaths in the US were caused by medical error that year."

uslic0013• 10 years ago

The way they guessed this completely made up number and the fact that it is being reported as real is sad. I can count on one hand the number of deaths caused by medical errors I have seen in my 25 years in medicine. Most errors do not lead to any morbidity or mortality. If this was a real number every person would have numerous relatives that had died due to medical errors. This is not the case. These fanciful fear mongering reports do nothing to reduce medical errors.

phogel• 10 years ago

I've spent years building systems that validate human action/decision in a clinical context (giving meds, transfusing blood, etc.). The environment is error prone and the technology in place is disparate and often operates on incomplete information. It's ripe for automation/optimization.

It was scary to see how quickly a new safety feature stopped a potentially catastrophic error.

http://www.patientsafesolutions.com/patienttouch-clinical-wo...

gshulegaard• 10 years ago

Possibly a horrible finding, but this line makes me skeptical:

They extrapolated that information and found that 251,454 deaths in the US were caused by medical error that year.

I would be interested to see their methodology, but it sounds tenuous.

TallGuyShort2• 10 years ago

My first thought was the likelihood of dying from something that was misdiagnosed or not caught in time. That could be considered medical error but is a whole different ballgame from, "they accidentally prescribed cyanide."

TallGuyShort2• 10 years ago

However, their point is not about assigning blame, it's about tracking how many deaths could possibly have been prevented by improving the system rather than ignoring everything but diseases that put people in the system. So now that I think about it, it makes just as much sense to track and improve misdiagnosis just as much as mistakes in the pharmacy...

mikestew• 10 years ago

Every time someone in the medical field tells me about how dangerous motorcycles are, I remind them of the woman I knew (world-class rider in some aspects of the sport) who was in a motorcycle crash. The crash didn't kill her, the people giving her the wrong drugs did.

Years later I read _The Checklist Manifesto_, only to be horrified that not only did medical personnel need to be told to use checklists, many resisted the idea. It's one thing to kill people because of a mistake, we all make them and thankfully the ones I make usually don't get anyone hurt. But it's quite another to kill someone because your industry is one step ahead of using leeches. I mean, suppose I make a commit that rolls into production and takes out production data. Someone asks, "did you follow the checklist?" If I say, "yes", it's unlikely that heads will roll and we'll update the list when we find out what went wrong. But if my answer is, "no. In fact, I don't even have a checklist/documented procedure, I just make sure my commit message is informative and hope I remembered everything", I'm likely to get fired. A doctor does it, shrugs it off with "we did everything we could", and a lot of time we all just go on about our day.

smileysteve6• 10 years ago

But if my answer is, "no. In fact, I don't even have a checklist/documented procedure, I just make sure my commit message is informative and hope I remembered everything", I'm likely to get fired.

Or even, the nurse has a checklist, but I don't need checklists, I'm a professional.

sopooneo• 10 years ago

I can not think of a single good reason to avoid check-lists in the medical field. And the doctors who resist them may very well just be arrogant and elitist. But there may also be some other reason. I don't know because I'm not a doctor, but I do know there are always things I don't know to consider in unfamiliar fields.

Do we have any doctors on the board who could explain a defensible resistance on the part of doctors to using checklists?

794CD014• 10 years ago

Not a doctor, but familiar with some of the arguments.

Visible use of checklists damages patient trust. You may (correctly) argue that patients who see their doctors following checklists should trust them MORE rather than less, but most data shows otherwise. Patient trust is very important not just for improving outcomes (they need to follow your instructions after discharge) but also in selecting a physician. That's why checklist use is higher in the OR, when the patient is unconscious.

Checklist use is slower. Virtually all physicians are already overscheduled. Lengthening every visit by 30-50% so that the doctor can go over a checklist that only ends up mattering a tiny percentage of the time means fewer patients get seen.

leonth6• 10 years ago

I am not a doctor, but I do have several practical defenses (I don't want to go through political ones).

There are many business processes in the healthcare field, and the impact and ease of imposing checklists will be naturally very different for each:

* Diagnosis and treatment protocols / pathways - these span long periods of time (days to months), any checklist will probably be quite complex and redundant to the already existing longitudinal case notes.

* Procedures (like surgeries) - some parts like preparation can be subject to checklist. But the procedure itself may need >= 2 clean hands and good concentration, thus glancing over checklists multiple times during procedure, or worse attempting to tick off stuff might cause more harm than good. (don't tell me to add one more guy there - we need him to save another patient, and google glass is dead for now)

* Processes related to ordering, dispensing, and administering medicines: there are probably tens/hundreds of thousands of these processes happening in a hospital at any given day. If a checklist introduces speed penalty it will be rather burdensome for the facility (and patients too). Furthermore, an equivalent of a checklist (e.g. refusing to proceed unless certain required fields are filled) has usually been codified in the hospital systems being used. Also, I feel that adding a checklist for something that you do hundreds of times a day, will not achieve anything, because the muscle memory will take over - you will just do things as per usual and sign off "all done" on the checklist, because you always do them all the time whether you remember or not, right?

IndianAstronaut2• 10 years ago

It is likely the same reasoning behind why doctors for ages refused to wash their hands...arrogance.

ndesaulniers• 10 years ago

There is no US system for coding these deaths

Because admitting to malpractice would be admitting guilt.

good_sir_ant2• 10 years ago

Good to know medical licensing is there to ensure our well-being, in addition to streamlining the entire medical marketplace.

twoarray• 10 years ago

In other places, it's even worse:

http://gawker.com/5954179/when-oopsies-leads-to-death-studen...

kazinator• 10 years ago

What is the algorithm for deciding, in every case of death, whether it was "medical error" or something else?

kiloreux• 10 years ago

I lost my father at a very young age (I was 14) because of a medical error, and we had to go through a lot of things to keep food on the table, now as much as I think the US system might has more justice than my country, where the doctor is still working and we never got compensated 1$ for such death, I wish that never someone goes through the things we have passed through because of a horrible medical error.

fiatjaf2• 10 years ago

I'm sorry.

djyaz12002• 10 years ago

This is a problem technology could dramatically reduce if each of us had a complete medical/medication history that was immediately accessible to the physicians/institutions treating us. That doesn't exist now unless you're getting all your treatment/meds from one company/hospital system (Ex: Kaiser). Right now if you (or your spouse/kid) are brought to the ER unresponsive the doc isn't going to know shit about what meds you are on, what you're allergic to or perhaps even why you're unresponsive in the first place... in the case that they do have information it is likely incomplete. It's not the slightest bit surprising this routinely leads to bad outcomes because doctors are guessing. Dr. William Yasnoff (MD & PhD Computer Science) has suggested the concept of "Health Record Banking." Similar to financial banking institutions would compete for the right to host your health data and providers could "withdraw" records and "deposit" records. Your smartphone would be a key portal to access this information securely. I'm not sure what the perfect solution is here but the Hacker News crowd is going to have to be the folks to fix this because government, doctors and insurance companies are not.

akerro• 10 years ago

This is a problem technology could dramatically reduce if e

This problem doesn't exist in 2nd and 3rd world countries and didn't exist in US two decades ago.

djyaz12002• 10 years ago

I'd say this issue gets more severe as the complexity of care delivered increases. The more providers, docs, meds are thrown in the mix the more likely it is that there will be an error. If each of us had realtime records when the doc ordered a medicine we are allergic to their computer system could have a fun little pop up like the Microsoft paperclip guy that said "Hey, looks like you're trying to kill this patient by administering a drug they are allergic to press ok to proceed or X to cancel.

iak8god• 10 years ago

This is a problem technology could dramatically reduce if each of us had a complete medical/medication history that was immediately accessible to the physicians/institutions treating us. That doesn't exist now unless you're getting all your treatment/meds from one company/hospital system

Local / regional Health Information Exchanges and efforts to combine them at the State level are now chipping way at this problem. An example is the Statewide Health Information Network for New York (SHIN-NY): http://www.nyehealth.org/shin-ny/what-is-the-shin-ny/

The main challenges are not technical (though data integration must be a nightmare and is almost certainly being done in a wrong and mostly useless way), but social.

felix_thursday• 10 years ago

So, does this mean people are more okay with giving Google all that NHS data now?

brent_noorda• 10 years ago

So "googling" our personal health data would serve the doctor 40% google ads, 50% bait, 9% invalid information put there by some crackpot, and 1% (buried in there somewhere) of actual valid data?

hotpockets2• 10 years ago

Makes me wonder why there's no war on medical errors. Humans are weird. We've evolved to fear most our prehistorical number one threat: other humans. This leads us to waste so much money and to continue sacrificing our own children, spouses, and relatives.

rictic• 10 years ago

Interesting blog post on the subject: https://blog.jaibot.com/foes-without-faces/

hotpockets2• 10 years ago

Very apropos link. Thanks for digging it up.

BurningFrog• 10 years ago

I'll just point out that what is the "Nth biggest cause of X" is entirely dependent on what classification scheme you've chosen for causes of X.

The article is better than most in pointing out that it's 9.5% of all deaths in the subheadline.

ilamont• 10 years ago

The older I get, the more stories I hear involving friends or relatives subjected to poor medical care or advice. The case that leaves me shaking my head involves a friend who had a surgical sponge left inside his leg during a procedure which almost led to his death some months later.

When it comes to errors resulting from misdiagonses: An experienced doc/med school professor once told me that they are unable to diagnose 10% of cases that come to his hospital (i.e., don’t know the cause of the ailment/symptoms).

timmytokyo• 10 years ago

One way to improve the situation is awareness. The Leapfrog group has established the "Hospital Safety Score" web site to check a hospital's safety "grade" based on publicly available information. Punch in your zip code and examine all the hospitals near you. The next time you or a loved one needs to go to a hospital, only choose among those that received an A. If enough people start doing this, the hospitals with lousy safety practices will start to get the message.

http://www.hospitalsafetyscore.org/

et2o6• 10 years ago

In this thread: people who have literally no idea what they're talking about spouting off.

I hope it isn't this bad when I read things about other fields.

therobot24• 10 years ago

what do you mean, i bet some of these guys launched a landing page about a medical startup app that got at least a series A...

josephpmay• 10 years ago

It's called the Gell-Mann Amnesia Effect

mej10• 10 years ago

That is a basic tenet of the computer career personality.

They've been rewarded for how smart they are their entire lives, so they think they can understand things completely by reading a few paragraphs about it. Even worse if they have one life experience that somehow totally justifies their view of an entire field that varies _dramatically_ from provider to provider.

It is the same reason every software person living around SF thinks they are economic geniuses because they got rich by being lucky.

The anecdote about a motorcyclist bringing up a medical error causing a fellow motorcyclist to die -- as if this somehow makes riding a motorcycle safer? What the actual fuck.

Spend a few days observing a large trauma ICU and they will rethink their story about motorcycles. People have no fucking idea.

et2o6• 10 years ago

Honestly I can't imagine this being possible. They must use an extremely broad definition of medical error.

tn134• 10 years ago

Shallow journalism by Guardian. More access to medical care means more people go to hospitals and live longer and hence there is a good chunk of deaths that were preventable if doctors or hospitals did better. This is not same as saying 'Doctors are killing people'.

The correct way to judge this number would be to see what % of people have access to medical care.

givan• 10 years ago

I don't understand why there is no good rating system for doctors, we have it for restaurants, hotels etc but not for doctors?

Yes doctors are more complex but the rating system can be improved over time by feedback and observation and this system can help filter out the doctors that became doctors mostly for financial reasons.

uslic0013• 10 years ago

Because most patients rate doctors based on whether they were given what they wanted rather than if what they did was medically correct. If you fail to give a patient a pain medication or an antibiotic you get a bad review even though it was the right thing to do.

0xdeadbeefbabe• 10 years ago

I ate too much. Is that the first cause of death in the US?

bawana• 10 years ago

You mean the health care sector has gotten so good at fixing all the other causes of death that what we see is the 'noise in the system'?

I think not. You cannot legislate good care on the backs of physicians. Or physicians will go on strike just as they did in the UK last week. In 3 days, 40,000 surgeries were cancelled. 80,000 office visits cancelled. But the PR people were quick to get on the tube and with their constipated smiles reassure the public that there were no problems. How many of those people died? We'll never know.

In the US, as long as insurance executives cut physician payment in favor of hospital bureaucracies and executive compensation, HMOs pile on the regulations to reduce utilization, physicians are slammed left and right to guess what's right instead of doing the necessary tests- there will be progressively LESS quality care. Checklists do slow down care delivery AND they are insufficient. Errors snowball because a sick patient is like a set of dominoes ready to topple. Just because the surgical site was properly marked and the type of operation was verified, does not mean that the patient will not fall off the stretcher when 5 people have to struggle to move an inanimate pile of flesh from the operating table to the gurney. The more people involved in a given endeavor, then the likelihood of error increases. We need to strive to simplify care, not complexify it.

We have already shipped many of our manufacturing jobs overseas. At this rate, much of our medical care will go the same way. The upper echelons of the the insurance companies and the HMOs will enjoy their views of the New York skyline while they figure out how to outsource health care to Cuba.

We also need transparency on costs. Once we get the REAL data, improvements will inevitably follow.

We also need REAL data sharing. There are 453 electronic medical record systems now in the US and they don't talk to each other. 453 versions of 'microsoft-like behavior' obscuring the flow of information. It's too funny to think of HIPAA in an era when the NSA already knows everything. And people are always blabbing about their health problems anyway. Just stand in line at Panera, Starbuck's.

AzzieElbab• 10 years ago

Having worked in health care IT in the US and Canada, all I can recommend is 'do not get sick'. Even if the data is right, there is a 50/50 chance medical practitioner will misread or ignore it

greedo5• 10 years ago

My GP blew a diagnosis that should have resulted in my early demise. He took down my symptoms without doing an exam (duh) and then a year later decided, yeah, maybe that colon cancer isn't a hemorrhoid... Only reason I'm still here is pure luck and the grace of God.

droopybuns• 10 years ago

These kind of stories make me feel like the medical & insurance industry has a strong undercurrent of corruption that people are reluctant to address.

desireco42• 10 years ago

I think we need WAR ON MEDICAL ERRORS ! ! !

:) Joking of course. But anything else would require us to address the problem.

nwah12• 10 years ago

Robotic surgery has way lower error rates, but people are so scared of anything new.

haldujai2• 10 years ago

This is blatantly incorrect. All of the latest evidence suggests that robotic surgery is not associated with clinically (or even statistical in many cases) significant improvements in patient outcomes when compared with other minimally invasive techniques (laparoscopy), currently the only field where robotics may have some benefit is in urology and even then, it isn't all that clear. Robotics have clinically significant improved outcomes only when compared to open procedures.

No one is scared of robotics but it costs the hospital a lot more money to run the DaVinci system and it requires significantly more OR downtime to prep between cases reducing OR utilization and the number of cases you can do.

Robotics may one day be the answer but not yet.

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254844/ 2. http://link.springer.com/article/10.1007/s00384-016-2516-7

nwah12• 10 years ago

But that's just it. For instance, the FDA just the other week denied approval to a hopeful competitor to DaVinci, called SurgiBot. This is preventing competition from driving costs down. Hopefully the big new entrants, Johnson & Johnson in partnership with Google, will have enough clout to shake things up.

It is not only difficult to bring new products to market, but also difficult to improve existing products. The 510k application process is claimed to be getting less onerous, but yet it still takes over a year to get a decision after submission.

It's just hard to get anything out there in our highly regulated, litigious, and fearful society. The rapid iteration that we like to see in tech can't do its magic in this environment.

noam872• 10 years ago

As someone who's experienced the medical system for the past 6 years (family and personal illness) and know many medical professionals, the level of arrogance, ignorance and lack of professional integrity frankly borders on criminal. It is long overdue to shed light on this issue.

Good doctors are few and far between.

Stories of mind-boggling ineptitude are so common that my only advice is: if you ever find yourself in need of medical care for anything major, your number one priority is to do your own research and micromanage your physician at every step to ensure he doesn't fuck up. Or he will. Big time. From the diagnosis stage to the treatment stage. Question his every decision because your life depends on it.

Trust me when I say this advice could save you from so much pain and sorrow many times over. I speak from experience. No not just one occurrence that left me bitter, but seeing it happen over and over. Being in a position where your life or the life of a loved one depends on people whose judgement you don't trust can be really emotionally taxing.

I would go into specifics, but this is not an anonymous account. I can only say in the medical profession, ineptitude and arrogance are the norm. The stories you read in these threads, they are common enough that I've seen these things happen again and again with my own eyes.

6stringmerc• 10 years ago

As much as somebody might read the above and say, "Oh wow, it can't possibly be that bad! This sounds like an axe to grind!" - hold that thought.

There's a lot of truth to what's been listed above, and the message that your #1 priority should be to micro-manage your care is actually good advice for above-average intelligent people. I can't stress this enough.

As with the parent comment, I shy away from sharing too much personal information about my own health battles. They are from birth, ongoing, and likely to stick around until I die. Want to hear something that would shock you?

My parents were advocates for my care and our insurance would pay for an innovative, proven type of new corrective surgery. The "Team" of a Head Doc and a couple others on his staff said over and over that my parents were being too pushy and that they would be the ones to decide when I would be a candidate for that surgery. My parents questioned their integrity, because it was obvious that I was a candidate.

The Head Doc got very arrogant. My parents got legal. What did they find? In the Head Doc's own notes, and agreed upon by his team in private, that I was an excellent candidate for the type of surgery being mentioned. They were lying to us, and for what?

We got a different Specialist after that. I'll never forget that lesson though, and later, having seen that Head Doc at an industry event later in life - he noticed I was doing well - to which I replied that indeed I was and no thanks to him either. Glad that asshole has retired.

kharms• 10 years ago

There's a lot of truth to what's been listed above, and the message that your #1 priority should be to micro-manage your care is actually good advice for above-average intelligent people. I can't stress this enough.

You can micro-manage yourself to an early death thanks to the Dunning-Kruger effect. If you can afford it, a good course of action is to (a) get second opinions from trained professionals, and (b) research your doctors.

ChrisDutrow3• 10 years ago

What was his motive for lying?

vgoh1• 10 years ago

I see a lot of posts on this thread blaming overworked, tired, well-meaning professionals that just can't do right, but I think you hit the nail on the head. In my experience, arrogant pricks are just attracted to becoming medical doctors.

I haven't gone to the hospital or doctors too much in my life, but every time, I come away astonished at their attitude, and wondering how is it that people can call a doctor a hero. When I went to the hospital to get my gall bladder taken out, I was in the worst pain of my life. I needed pain killers, and could hardly talk, and they spent 10 minutes getting my billing information before a doctor would even see me. When the doctor finally game in, I wasn't screaming or anything, even though I wanted to, just curled up in a ball, and the doctor rolled his eyes at me like a teenage girl - I instantly became more scared of being cut opened by one of these assholes than of the pain I was in.

Before this, I had been misdiagnosed several times - I had to figure out it was my gall bladder from Google, and work hard to convince my doctor to even explore the possibility it was my gall bladder. I had to TELL HIM that not all gall stones are visible on an ultrasound. Before that, I had minor bladder issues, which the doctors turned in to a major issue by constantly putting catheters up me, and prescribing me several medicines to "see if they work" even though they all said to not take if I was experiencing the exact same symptoms that I had told them about.

I almost had a surgery for the problem - my doctor would always tell me that the surgeon would discuss possible side effects before the surgery - I was trying to get info at least days before the surgery, so I could sleep on it and make an informed decision, but I wasn't able to talk to him until right before they were going to put me under. When I continued to press him for questions, he was huffing and puffing, like a teenage girl, any other grown man would have been embarrassed to act like that. After pressing him, I finally found out that a very likely side effect of the surgery would have put me in a much worse situation that the problem they were going to fix - it would have turned minor but annoying irritation into me needing to wear adult diapers for the rest of my life! And he was visibly angry for having to tell me that! Of course, I canceled the surgery.

I could go on and on, like how I was lied to about my bill, telling me it would be around $250, but was really $2000, for tests that i didn't want, and knew would come up negative, or how my daughter was born early but healthy, and simply in the NICU for observation for 2 weeks, at $5000 a DAY, sitting in an OLD incubator, with one nurse watching a few kids. I, for one, can't WAIT until WATSON takes all their jobs.

adanto6840• 10 years ago

I very recently went to an ER, had absolutely mind-blowing levels of pain, got in right away (the ETA #s shown live on their site probably went down, that fast), only to be told I needed:

  -Brain CT
  -Cervical spine CT
  -3 or 4 X-rays

I asked how much a might cost, having no insurance -- to which the lady looked at me like I was nuts; I just figured, hey, let's start with X-rays and go from there... Her actual answer was "I don't know, I can call the billing department if you'd like?" I was partially embarrassed, mostly just in pain, and frankly ready for some actual guidance/help. I basically just said "Okay, whatever, go go go, figure out what is wrong with me now!". No idea what it'll have cost yet, I'm putting the over/under at $3.4k though, heh.

I ended up leaving in more pain than I arrived in; after I suggested some possibilities based on Google they, seriously, looked it up on YouTube including how to test me for it (TOS / Thoracic Outlet Syndrome), then proceeded to give me an injection of muscle relaxer which didn't help at all, and then released me. I'd have been better off taking another 4-8 ibuprofens at home.

Thankfully I do actually have a fantastic, dedicated, caring, highly intelligent doctor who I saw right away on Monday -- severely herniated cervical disk (MRI imaging is amazing BTW).

Idk if I look like a drug junkie or what, but that was one of the worst days my life for both myself & my wife.

noam872• 10 years ago

Yup, Google literally saved my life. If it were up to both doctors (yup, I did get a second opinion), I would be dead today.

My condition is neither rare nor difficult to diagnose. My symptoms might as well have been lifted from a textbook.

My family member wasn't so lucky and died due to: a) Doctors again unwilling to diagnose in time until symptoms were impossible to ignore. b) They abandoned a treatment that was working for one that didn't. -- Not to mention that time he almost died during treatment because of a medication dosage mixup.

It's an industry run by imbeciles. Those within it who want reform are met with so much resistance it's maddening -- just having these stats out in the open is a triumph. I too can't wait to see the day a piece of software knocks them off their high horse.

ythl2• 10 years ago

It doesn't mention what #2 and #1 are, but based on the amount of attention gun control gets, I'm assuming guns are either the #1 or #2 killers.

cpncrunch• 10 years ago

The article itself says cancer and heart disease are #1 and 2.

ythl2• 10 years ago

Yeah but america has a huge gun problem so I'm assuming it's in at least the top 5.

briantakita• 10 years ago

Iatrogenesis - https://www.wikiwand.com/en/Iatrogenesis

I learned about this concept in http://www.amazon.com/Antifragile-Things-That-Disorder-Incer...

PerfectElement• 10 years ago

A while ago I was watching a great talk by Dr. Greger [1] where he listed the top 10 causes of death and how to prevent them. I remember being surprised when I saw "doctors" listed as a leading cause of death. I don't remember what his advice was on how to prevent doctors, so I'll have to watch it again.

[1] https://youtu.be/30gEiweaAVQ

erikb• 10 years ago

I hope it becomes first one day. Think about a world where our medicine is so good that most other causes of death aren't as severe. Then the only serious thing left is some margin of human error. And even that may decrease as the technological support improves.

joesmo• 10 years ago

Considering how often healthcare professionals work without sleep is this surprising? Nothing short of ordering sleep and preventing professionals who haven't slept from working will really put a dent in this problem. And the only thing that will get this done is regulations. Until then, people will continue to die and others will continue to push against regulation killing people in the process.

hermannj314• 10 years ago

Wasn't a major premise of the Affordable Care Act that it was the lack of access to medical care that was killing so many people?

Glad to know the situation is better now.

pascalxus• 10 years ago

Another side effect of Medicare and Medicaid overfunding. According to AARP, people are getting way too much medical care - to many surgical diagnostics and procedures putting people at increased risks.

maxerickson4• 10 years ago

Medicare pays less than any private insurer.

Medicaid pays less than Medicare.

musha68k• 10 years ago

"Never touch a running system."

Complexity kills!

soufron• 10 years ago

After the food ?!?

Roboprog• 10 years ago

#include std_disclaimer.h

I work on the team that maintains the CA Electronic Death Certificate System. Yesterday, our supervisor sent this out among the team.

The certificates have spots for immediate and contributing cause of death. We are working on a system for doctors to enter this information (tie in our system to the hospital's) while it is fresh in mind for the staff, and to gather the info in near real time for NIH after finalization.

However, even as a programmer, I think it is harsh to expect a doctor to self critique himself/herself in that position (assuming he/she were so inclined). As one of the commenters on one of the articles about this study pointed out, it used to be automatic that a death in the hospital went to the coroner. This would allow a somewhat neutral, educated, third party to asses for procedural errors and the like.

Are we, in the continuing age of Reaganism in the US, ready to budget for that sort of backstop to find, analyze and correct these kind of problems?

Gatsky• 10 years ago

Lot of sad stories here, along with understandable mistrust of doctors. However, the most outrageous point thst emerges from the article is that in the US nobody is even measuring the rate of medical error. That is a criminal failure at the government level.

fiatjaf2• 10 years ago

Well, this is a problem created by the State and its medical licenses.

At the time anyone with a medical license is just a doctor as anyone else, because they all have the same license, disappears the need to show your potential patients that you are indeed a doctor that cares about quality.

wodenokoto• 10 years ago

Something has to be the biggest, second and third cause of death.

In a perfect society,what is the number one cause of death?

alyx• 10 years ago

Anybody know of any good self-help/research communities or forums?

Search engines are filled with clickbait these days.

jayess• 10 years ago

250,000 people a year are killed by medical mistakes. 11,000 are killed by guns. So you're 22 times more likely to be killed by a medical professional than someone with a gun.

In fact, since there 19,000,000 medical industry employees in the United States, and 300,000,000 guns (and probably somewhere around 100,000,000 gun owners), you have a 1.3% chance of a medical professional killing you and a 0.01% chance of a gun owner killing you.

bainsfather• 10 years ago

I think you mean: "A medic has a 1.3% chance of killing someone this year".

hNewsLover992• 10 years ago

Interestingly, but not surprisingly:

1) Like the hundreds of comments attached to this post (or at least the ones that I have read) today's mainstream media coverage of the Johns-Hopkins study (or at least the reports that I have seen) omits the study's admission that it understates the total "medical error homicide rate" (SEE NOTE 1 BELOW) (by not including similar fatalities at nursing homes, outpatient clinics and other non-hospital settings).

2) As a result, most people who viewed that coverage now incorrectly believe that annual medical error homicide rate is a paltry 250,000, when in fact it has previously been estimated to be nearly twice that number. See, e.g., the 2013 study reported by HuffPo, in which the total figure was estimated in 2013 to be over 440,000. (SEE NOTE 2 BELOW.)

That's like losing the 50,000 U.S. soldiers lost during the ten-year long Viet Nam War every six weeks, month after month, year after year, decade after decade.

3) A condition imposed by the hospitals submitting to studies of this sort is that findings of error cannot be disclosed to the victims' surviving families or legal representatives (who, of course, are legally authorized to access the victims' patient records, and to assert claims on behalf of their estates). Stated differently, the medical profession can be induced to examine its inadequacies only if it is first favored (bribed?) with perpetual immunity, anonymity and concealment.

4) It is unknown (or at least unreported) what percentage of medical error homicides: - Are ever disclosed to surviving families, - Lead to professional conduct investigations, and to sanctions, - Lead to claims or suits, - Go uncompensated, or unfairly under-compensated, or - Are fairly compensated, both before and after legal fees and expenses.

5) As a result we cannot know the size of the economic windfall enjoyed by the perpetrators of these homicides, their stockholders, and their liability insurers.

6) But we can make some rough hypothetical calculations. If, for the sake of argument, half of the families of the 250,000 (or more likely 440,000) annual victims of medical error homicide were reasonably entitled to a $2 million (gross) recovery, but received nothing, then the annual saved-liability windfall would be $250 billion (or, more likely, $440 billion). Year in, and year out...

7) If the true economic costs of medical error homicide, of fraudulently-evaded civil compensation for victims' families were ever known, perhaps a different light would be cast on the ceaseless whining by the medical profession, insurance industry and political conservatives about "too many" medical malpractice suits.

8) Medical and support staff who withhold or misstate the actual facts of a patient death or injury caused by medical error can (and should) be, but rarely are, prosecuted for violating state and federal wire, mail and other anti-fraud statutes.

9) All citizens can and should do what they can to reduce medical error homicide rate. For example, when victims' families can identify staff who commit, fail to report or attempt to conceal such errors, they should demand civil and criminal justice and professional conduct investigations and discipline.

10) And in cases of extreme recalcitrance by medical professionals and staff, a little public shaming should not be out of the question.

NOTE 1: As used in this comment:

"Medical error homicide" refers to an erroneous, and therefore negligent iatrogenic event that causes the patient to die. This term and its definition reflect the fact that intent to kill is not a required element of a homicide.

"Medical Error Homicide Rate" is the number of medical error homicides committed in a calendar year.

NOTE 2: Sources:

http://www.huffingtonpost.com/allen-frances/why-are-medical-....

http://www.hospitalsafetyscore.org/newsroom/display/hospital....

hNewsLover992• 10 years ago

CORRECTION: "Medical error homicide" refers to a medical error (i.e., an avoidable iatrogenic event, such as mis-calculating a dosage by making a math error, as in the famous case of the Boston Globe medical journalist, Betsy Lehman), which is negligent as a matter of law, and which causes or substantially contributes to the death of the patient or any other person. This definition reflects the fact that intent to kill is not a required element of a homicide.

slr555• 10 years ago

This statistic gets bandied about every now and then and is completely indefensible. Extrapolation is hardly proof and the CDC statistics don't begin to validate this nonsense.

If it were true it would mean that for essentially every person you had ever heard of dying from any type of accident or pneumonia there would be one resulting from medical error.

Every fatal car wreck you ever read about. Every drowning. Every fatal accidental shooting or fall AND every person you had ever heard of dying from lower respiratory tract infection would have an approximately equal number of deaths CAUSED by medical errors.

In other words people who would have lived instead died because a medical professional made a mistake.

If you believe that's true I have a wonderful bridge here in Brooklyn I would be happy to sell you for a very reasonable price.

known• 10 years ago

https://en.wikipedia.org/wiki/Second_opinion should be made compulsory

throwaway049• 10 years ago

I recommend this lecture "Designing IT to make Healthcare safer" by Professor Harold Thimbleby as being of interest to people on here. There's a video and a transcript.

http://www.gresham.ac.uk/lectures-and-events/designing-it-to...

shirro• 10 years ago

Medicine and road transport are two areas where I hope AI can save us from ourselves because both produce a huge public benefit but they are both hopelessly prone to errors with deadly consequences.

perilunar• 10 years ago

The comparison between Medicine and Aviation has been discussed here before: How mistakes can save lives: one man’s mission to revolutionise the NHS (newstatesman.com) https://news.ycombinator.com/item?id=7865917

spectrum1234• 10 years ago

Didn't read the article but this could be a very good thing. It could mean that health care is extremely good at saving lives so the only thing left is error.

DyslexicAtheist• 10 years ago

Nassim N. Taleb touched on this in Black Swan and even more aggressively in Antifragile[1].

[...]

Overtreatment of illness or physical problems, he suggests, can lead to medical error, much the way that American support of dictatorial regimes “for the sake of stability” abroad can lead to “chaos after a revolution.”

[...]

[1] http://www.nytimes.com/2012/12/17/books/antifragile-by-nassi...

bitL• 10 years ago

An opportunity for automation and for MDs to take more rest...

ransom1538• 10 years ago

Doctors routinely avoid questions: "How many times have you performed this procedure." This question COULD save your life. Always ask. Experienced doctors will give you a hint through body language. Younger doctors will become nervous and avoid any questioning. If you are told there will be another doctor assisting: AVOID.

Shameless plug: I am committed to fixing this. IF you want to join me let me know. https://www.opendoctor.io

MaPaAbCa• 10 years ago

Does anybody has world breakdown figures for medical error, please?

Medical error is third biggest cause of death in the US, experts say

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