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Medical error in hospitals is the third leading cause of death in the U.S.
- HillaryBriss 10y agoThe original study's authors suggest adding a field to death certificates where the hospital personnel would put additional information about the cause of death: ... death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death. How could they do this and, at the same time, shield themselves from lawsuits which use that "extra field" as evidence against them?
- x5n1 10y agoYou could pass a law to prevent or limit the amount that can be sued for negligence. It's I believe the case in Canada.
- Zigurd 10y agoFor a system that appears to be having a problem putting in quality controls, limiting liability runs the risk of having those limited payouts turn into a cost of doing business.
- x5n1 10y agoWell if you publish these cases online the hospital will lose substantial business. So it's like a canary. At least you are getting information about what's going wrong, and then you can put pressure on the management to fix it via other means like regulation, penalties, or whatever.
- TeMPOraL 10y agoOTOH doctors now do serious liability limitation by constantly worrying over their exposed "attack surface" in case something goes wrong. Having your medical staff being forced to be more worried about legal repercussions than well-being of their patients is not exactly healthy for anyone involved. Compare with aviation industry, where considerable effort was made to treat accidents as systemic problems and a) making sure individuals won't get immediately blamed for stuff that's not really their fault, and b) that everyone can learn as much as possible from every mistake made so that they don't happen again.
- dragonwriter 10y agoMalpractice limits exist in some jurisdictions in the US. Studies have shown that they do not have meaningful effects on the cost of liability insurance or the practice and cost of healthcare. (Which kind of makes sense: the limits are always adopted to prevent what are seen to be "extreme" awards which are awarded -- from the perspective of proponents of the limits -- by runaway courts/juries, or -- from the perspective of opponents -- for the most egregious incidents of malpractice; these make up a very small share of all awards and have a negligible effect on either a practitioner's or an insurer's exposure. You'd have to limit malpractice awards at a level that would affect common and uncontroversially warranted awards to have a meaningful effect.)
- saint_fiasco 10y agoThat has the unfortunate effect of anchoring the amount so many people who would have sued for a modest amount see the limit and sue for that amount instead.
- jellicle 10y ago> How could they do this and, at the same time, shield themselves from lawsuits Why is that a desirable goal?
- x1798DE 10y agoBecause otherwise no one would use that field, and you might as well not have it at all.
- Spooky23 10y agoHospitals are a mix of stakeholders, all of whom have different agendas. There's something to be said for a blame-free environment where you can actually get honest post-mortem assessments.
- blahedo 10y agoBecause if not, you provide them with an extremely compelling incentive to lie.
- mhuffman 10y agoSo they could have a consequence-free way to accumulate analytics to make healthcare better. If you have no metrics of a problem, you have no idea how big the problem is, right? Or if a problem needs to be solved. Or how.
- Zigurd 10y agoIn many arguments about socializing medical care, the "fact" that the US has "the best medical care in the world" is cited as a reason to keep the status quo. instead it appears we are paying through the nose for a system that doesn't manage quality very well at all.
- jessriedel 10y agoIt's certainly debatable which countries get the best medical care for the dollar, or which countries distribute it to people in the most fair way, or make it most accessible to the poor. But I don't really think there's debate that the US gives the best medical care if money is no object. My understanding is that, with very few exceptions, the wealthy all over the world come to the US if they have a serious medical condition.
- Zigurd 10y agoBased on data, or based on image and marketing? [EDIT:] Interesting pair of replies: US medicine is envied by those "trapped" in socialized systems that won't give them a private room. AND over-regulation is the cause of quality problems. Now there's a 360 degree defense of market-based medicine!
- bpodgursky 10y agoBased on the fact the Mayo clinic does, in fact, attract the richest people in the world.
- phaemon 10y agoSo does Harley Street, in London. So what?
- Zigurd 10y agoIt's already been pointed out that Lamborghinis don't make Italy the world's best car-making country. And Lamborghinis are not even the world's best cars. The rich are particularly susceptible to irrational decisions about purchases.
- thegasman 10y agoNote the paper's definition of medical error: "Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome,3 the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning),4 or a deviation from the process of care that may or may not cause harm to the patient." That's quite broad
- darawk 10y agoIs it? Those all seem like pretty reasonable types of error. Ultimately they have to have contributed to the death of a patient to be included. If one of those things contributed to someone's death, I don't think i'd hesitate to call that a 'medical error'.
- gpm 10y ago> one that does not achieve its intended outcome I struggle to see how there are any deaths inside a hospital that don't fall into this category. E.g. a cancer patient on chemo therapy who doesn't make it would seem to qualify. Realistically I assume this means that they count whatever they want as medical error, with no good rules.
- surfaceTensi0n 10y agoI don't think your example would qualify unless a real error was made e.g. the chemo killed them so there was a planning error in putting them on chemo. The truth is that many people with cancer will not survive. In those cases, chemo is not about saving their lives, just extending them.
- aptwebapps 10y agoYou're saying what it should be but the parent comments are talking about what it actually says. Specifically, "one that does not achieve its intended outcome".
- Smudge 10y agoThankfully I haven't had many reasons to enter a U.S. hospital, but the few interactions I had were extremely worrisome. For example, when my grandmother fell ill, my family spent a lot of time visiting her. My mother, in particular, spent many days and nights there, and her biggest complaint was the complete lack of communication between shifts. Every few hours, someone new would come into the room, read my grandmother's charts, wake my grandmother up, and ultimately misinterpret several important details. Thankfully my mother was often there to correct them and fill them in on what previous nurses/doctors had already done, but the net result was that my grandmother barely got any rest (being constantly woken for no apparent reason) and, had my mother not been there, a nurse or doctor could easily have made a critical mistake when continuing her treatment. Another example, still the same grandmother. Even though her original condition improved (after having been rushed to a different hospital), she ended up going home with an entirely new infection which resulted in several more weeks of sickness and eventual recovery. The infection (C. Diff) is one of the leading Hospital-acquired infections and is in many cases totally preventable. It's hard to believe how many people die each year due to infections they pick up in hospitals.
- calcsam 10y agoThere's a startup, Medisas, that's aiming to solve this exact problem: https://www.medisas.com/transitions-of-care https://www.medisas.com/transitions-of-care
- blaze33 10y ago> her biggest complaint was the complete lack of communication between shifts. Hmm seems weird and easily addressable to me, I had to spend some time in a hospital in Paris (France) and the staff had a meeting between every shift to discuss how patients were going. To the point that people complained they weren't available at that time... But yeah no experience with US hospitals so YMMV.
- hellofunk 10y agoMost human errors are easily preventable.
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- djyaz1200 10y agoThe book "Black Box Thinking" by Matthew Syed has good insight on this issue, especially the differences between how the airline and medical industries handle errors.
- torbit 10y agonothing to do with death, but how hospitals don't know what they are doing sometimes. when I was really young I jammed my finger. went to the hospital to get it checked. they were putting a wrist splint on me. I asked how that helped my finger. he quickly took it off. If I was older I would have just tapped it up.
- tokenadult 10y agoA thoughtful point-by-point response to the underlying medical journal publication: "Are medical errors really the third most common cause of death in the U.S.?" https://www.sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s/ https://www.sciencebasedmedicine.org/are-medical-errors-real... Simply put, the headline of the article kindly submitted here surely exaggerates the actual problem. What's undoubtedly a problem is that we don't yet have good data-gathering about when patients die unavoidably and when they die when they could have been saved by standard-of-care medical treatment.
- carc 10y agoWhy is this being downvoted?
- extra88 10y agoMaybe because the first paragraph is a non sequitur swipe at the business of alternative medicine and two people in particular. Or maybe because there's apparently an online campaign against the article author. The first paragraph may not be so random in the blog's context, I expect a blog called Science Based Medicine would spend a lot of time doing battle with alternative medicine adherents, but it detracts from this specific article which does a good job deflating this medical errors headline.
- TrevorJ 10y agoI am ROUTINELY prescribed medication that I am not supposed to take. I have a drug allergy, and one other simple condition that both preclude certain medications being prescribed to me. These conditions do not change over time, and have been in my medical history for 20+ years and yet multiple providers have prescribed medication I can't take to me. I cross check all new prescriptions myself as a matter of course now.
- hellofunk 10y agoI can't say I'm surprised. I had a surgery once at a supposedly well-respected regional hospital, and they made several careless mistakes with me. Everything turned out fine, but there was considerable opportunity for easily preventable things to have gone wrong if it weren't for dumb luck.
- INTPenis 10y agoI wonder how many of those deaths were in public healthcare and in private healthcare? Speaking as a swede I am fed up with seeing how the government undermines public health care at every turn and promoting privatized health care. Health care workers aren't stupid, they're mass migrating from public to private sector. Leaving the public sector in very bad shape with no backup from the government to keep it running. If you like me believe that your health should not be measured by your wealth then it's down right disgusting.
- poof131 10y agoDisappointing, sad, and scary, but not unexpected. You can’t expect matters of life and death that effect liability, public relations, and profitability to be properly investigated and resolved by the entities directly involved. When an airplane crashes, the airlines, manufacturers, and pilots union don’t get to run the investigation and choose the results. Sure they are involved and try to influence the outcome, but an external agency heads the investigation. Medicine needs some sort of non-punitive external investigative agency. With the scope so much larger than aviation and death often being a normal outcome, how to structure such an agency would be challenging, but I still think it’s the only way to really address the problem. The same applies for law enforcement and the use of deadly force. While many of the people involved have the best intentions, the pressures of the organization put undue bias on any internal investigation. It looks like an agency along these lines may have been formed [1], but the ‘At the invitation of healthcare providers’ isn’t good enough. A quick google search found others pushing along these lines [3], and it’s interesting that they are talking about error being the ‘third leading cause of death’ in 2014. While critics point out that the study may have an overly broad definition of error, it still seems that there is an issue here from anecdotal experience, and that error shouldn’t even be in the top 10. [1] http://www.prnewswire.com/news-releases/pso-services-group-launches-national-medical-safety-board---nmsb-165958516.html http://www.prnewswire.com/news-releases/pso-services-group-l... [2] http://www.ntsb.gov/Pages/default.aspx http://www.ntsb.gov/Pages/default.aspx [3] http://safepatientproject.org/press_release/patient-safety-advocates-urge-the-creation-of-a-national-patient-safety-board-to-fight-medical-errors http://safepatientproject.org/press_release/patient-safety-a...
- Mz 10y agoWe had a discussion on this topic a week ago: https://news.ycombinator.com/item?id=11627213 https://news.ycombinator.com/item?id=11627213