Deaths From Medical Errors: Hell or Hype?

Doctors make mistakes.  There, I’ve said it.  More than having said it, I wrote it.  This confession has now been memorialized in cyberspace, where no piece of data can ever be truly deleted.  We have all seen how seemingly erased data has been resurrected by forensic experts to the horror and dismay of the eraser wannabees.

Doctors work on seriously ill patients.  They do their best to help heal them; or when this is not possible, to comfort them.  Some patients get worse under our care.  Some die.  This sober slice of the human condition impacts deeply on physicians and all health care professionals.

I acknowledge that medical errors have worsened patients’ condition or have even contributed or caused their demise, a tragic but unavoidable result of a noble endeavor that is imperfect.  I remind readers that physicians are members of the human species and have all of the flaws and frailties that every other homo sapiens creature possesses.   Every aspect of the profession is imperfect – physicians, nurses, medical devices, drugs, surgical equipment, hospital sanitation and the various processes and procedures involving scheduling, administering of drugs and blood products and labeling of specimen jars.  Indeed, no profession can boast 100% performance, although admittedly the stakes are higher in the medical arena than in many others.

Air Travel is not 100% Safe

Nearly 20 years ago, a report appeared in the Journal of the American Medical Association that stated that nearly 100,000 patients died as a consequence of medical mistakes.  Last year, the British Medical Journal raises this number to 250,000.  Many have challenged the accuracy of both of these reports, claiming that the quality of the studies’ interpretations is suspect.  While I have no opinion here on this challenge, I do offer two observations, neither of which is scientific.

• In my quarter century of medical practice, I have not witnessed a medical act or omission that clearly caused a patient’s death.   Of course, I have seen, and surely committed, plenty of mistakes and flawed judgments, but I cannot recall any medical act or decision that was the proximate cause of a patient’s death.
• It’s not a simple task to determine if a medical error was either responsible or a major contributor to a patient’s death.  For example, consider an elderly patient with history of a stroke and heart disease who is in an intensive care unit for pneumonia who is on a ventilator. A doctor mistakenly prescribes an excess of intravenous fluids and the patient develops congestive heart failure (CHF).  The CHF is treated but the patient’s condition deteriorates over the next 3 days leading to his death.  It’s not easy to accurately ascertain in this hypothetical example to what extent the doctor’s error contributed to the outcome of this seriously ill and elderly individual.   

I’m not carrying water for my profession.  Rather than fight over how many deaths doctors are responsible for, let’s work together on our shared mission to make our health care as safe as we can.