Features
When
Mistakes
Happen…
The Consequences of Medical Errors
Medical error has been described as a public health
emergency. Certainly, the numbers support this.
Opioid abuse – today’s exemplar of public health
emergency – claimed an estimated 42,000 Ameri-
cans in 2016, or about 115 people every day. 1 Using a
conservative estimate, the toll of medical mistakes is
about 250,000 lives every year, or about 685 people
every day. 2
“Whatever the precise epidemiology is, the
bottom line is that medical error happens far too
frequently and is an urgent problem that needs our
attention,” said Thomas H. Gallagher, MD, a profes-
sor of medicine and bioethics and humanities at the
University of Washington School of Medicine and
director of the University of Washington Medicine
Center for Scholarship in Patient Care Quality and
Safety. “There has been progress in the past two
decades, but not been nearly as much as folks had
hoped for.”
That progress was kickstarted almost 20 years
ago, with the publication of the Institute of Medi-
cine’s (IOM’s) report “To Err is Human,” a landmark
paper that launched the modern patient-safety
movement. 3
ASH Clinical News spoke with Dr. Gallagher and
other clinician-researchers about the prevalence
of medical error, its consequences for patients and
physicians, and the quest to “primum non nocere.”
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ASH Clinical News
A Problem of Unknown Proportions
The discussion about medical mistakes has been
growing louder since the 1999 IOM report: A
PubMed search for the term “medical error” yields
just eight hits from 1999, compared with 35 in the
year 2000 and 112 in 2017.
While “To Err is Human” was eye-opening,
the data it contained on the incidence of medi-
cal error were limited. The authors estimated that
between 44,000 and 98,000 deaths attributable to
unintentional harm occur annually, but this figure
was based on two limited studies conducted during
the 1980s and 1990s and is considered to grossly
underestimate the true prevalence.
A 2013 review of studies published more
recently – between 2008 and 2011 – found that
more than 400,000 patients die prematurely
each year due to preventable harm. Many more
are being seriously harmed, but not killed, by
medical error. 4
In his BMJ report, Martin Makary, MD,
MPH, a surgical oncologist at Johns Hopkins
Medicine and the creator of The Surgery Check-
list (an operating room checklist designed to
eliminate simple mistakes and to improve patient
outcomes), suggested that a more conservative
number of 251,454 deaths per year is more accurate.
That places medical error as the third most
common cause of death in the U.S., according
to the Center for Disease Control and Preven-
tion’s list of leading causes of death. 2 It comes
behind heart disease and cancer, but well ahead of
chronic obstructive pulmonary disease.
Pinning down the actual figures for medical
error–related mortality is a nearly futile effort,
largely because death certificates list only causes
with corresponding International Classification
of Disease (ICD) codes, and there is no ICD code
for “death by mistake.” Even the ICD-10 coding
system does a poor job of capturing most types of
medical error, according to Dr. Makary.
It’s not just the U.S. health-care system, either.
According to the World Health Organization
(WHO), 117 countries code their mortality statis-
tics using the ICD system as the primary indicator
of cause of death.
Dr. Makary has suggested that, to achieve the
goal of making health care safer, the community
needs to adopt a scientific approach – the same way
it already shares information about diseases and
treatments. “Sound scientific methods, beginning
with an assessment of the problem, are critical
to approaching any health threat to patients,” he
wrote. “The problem of medical error should not
be exempt from this approach.”
December 2018