“Human error is inevitable” a paper in the British Medical Journal observes. Nevertheless, the paper's authors are alarmed that an estimated quarter of a million people died as a result of medical mistakes in the U.S. in 2013. The figure, 251,000, is more than double suicide, firearms, and motor vehicle accidents combined, which is why the paper is a call for action to push the number down by calling for better reporting on this.
According to Professor Martin Makary and Michael Daniel, both of Johns Hopkins University, addressing the problem starts with acknowledging it. “Medical error is not included on death certificates or in rankings of cause of death.” they write. Consequently, it doesn't make it into the annual assessment of leading causes of death compiled by the Centers for Disease Control and Prevention, and therefore into public awareness or priorities for research and mitigation.
It's hardly surprising that physicians don't want to write “my screw-up killed the patient” on a death certificate. Not only is it a great way to get sued by the grieving family, many doctors may not be willing to admit their fault even to themselves. Nevertheless, without some grasp of the problem we're not going to fix it.
In such circumstances any attempt to quantify the problem has to be rough, but Makary and Daniel argue, “The science of safety has matured to describe how communication breakdowns, diagnostic errors, poor judgment, and inadequate skill can directly result in patient harm and death.” The figure they calculate of 251,000 is based only on deaths that occur in hospitals and excludes people who died after mistakenly being sent home, presumably making it an underestimate.
In order to improve reporting, the paper proposes several options. “Death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.” Perhaps surprisingly, a trial of this idea produced an 89 percent response rate. A likely more reliable, but also more expensive, suggestion is “for hospitals to carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of error.”
Challenging as such approaches may be to implement, without further action doctors are likely to remain oblivious to the most common avoidable mistakes. The paper includes a case history of a woman who was given “extensive tests, some of which were unnecessary”. A needle used in one of these tests “grazed the liver,” eventually leading to rupture and death. Yet the death certificate listed cardiovascular disease as the cause of death. Although it is possible the doctors involved were more cautious about such testing thereafter, other professionals would have been unlikely to get the message.
Estimates of the annual deaths from medical mistakes have been rising. Not long ago they ranged from 44,000 to 195,000, but recent attempts to quantify the problem include one that extends from 210,000 to 400,000. Although the authors consider their estimates more accurate than past efforts, the mere fact that there is so much uncertainty helps make their case that the issue requires more attention.
"Although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences," the authors conclude.
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