Published April 19 2017
While affordability of and access to health care has been debated for a long time in our richest country, the safety of the available health care is being questioned lately, and for a good reason.
In 1999, the Institute of Medicine estimated deaths because of medical errors as high as 98,000 a year and published a book titled To Err Is Human with a call for improvement.
In the middle of 2016, the British Medical Journal published a paper that estimated medical errors to be the third-leading cause of death in the United States, claiming up to 250,000 lives each year.
These are estimated and extrapolated numbers, subject to controversy. We could not have possibly gotten worse. According to the Centers for Disease Control and Prevention, about 715,000 people died in hospitals in 2010 — 75 percent of them age 65 and older and 27 percent age 85 and older. Can we safely assume or reasonably believe that one-third of these deaths might have been prevented if these sick patients did not come to the hospital?
Nonetheless, the fact remains that medical errors remain a real problem. Why is that?
Let us think of automobile accidents that cause preventable deaths and disability. These accidents happen for many reasons — condition of the road, condition of the automobile, condition of the weather, condition of the driver (impaired or distracted) and lack of compliance with rules and regulations, just to name a few. In spite of all the technological advances, as long as there is human intervention, all of the accidents can never be prevented. Is there anything more preventable than texting while driving?
Health care delivery is very complex, especially in a hospital setting. The patient is sick in the first place with associated anxiety and apprehension. So many different decisions made by different providers need to be perfectly communicated, calibrated and coordinated. Exposure to many medications, machines and materials brings all its unintended adverse effects.
An unfamiliar environment while the patient is already distressed or disoriented does not help. Injections, interactions, injuries and infections can all be potential killers. Lots of other things come into play, like machine malfunctions, material shortages, mind-numbing misjudgments and unacceptable attitudes.
Having said all this, I can assure you that there is no alternative to a hospital for a sick patient to have a fighting chance for survival. Over the past several decades, I have cared for thousands of patients that needed hospitalization, and most of them are still alive and doing well.
The health care profession tries very hard to avoid accidents and mistakes. I do not believe that any of them wake up on any given morning saying to themselves: Who can I kill today? There are lots of controls, checks, balances, backups and safeguards. There is mandated continuing education and vigorous vigilance. Every medical mistake is followed by extensive “root cause analysis,” with corrective actions to prevent recurrences. There are constant quality control measures, meetings and discussions. All medical errors are reportable. Health care providers are punished if mistakes are made, and malpractice liability is a great deterrent.
Not all deaths are avoidable — neither all medical errors — but many are. Medical mistakes can happen in outpatient settings also. The mistakes can be individual or systemwide.
Personal responsibility by the public can prevent a lot of deaths. (A topic for another time.)
A mistake can happen one time. But there is no excuse for the same or a similar mistake to happen a second time, especially by the same person or institution.
To err is human, but prevention is divine. The prospect of proper punishment is a great deterrent for a reckless driver or a negligent health care provider. Accountability is the backbone of safety.
First do no harm, as Hippocrates, the father of medicine, preached.
Even one life lost unnecessarily is too many, whatever the reason.