A report published in May from researchers at Johns Hopkins claims that medical mistakes are the third resulting cause of death in the U.S ., behind only heart disease and cancer.
According to the researchers, medical mistakes account for 251,454 U.S. demises each year and they regard this figure as an underestimate.
Thats the sort of find that stimulates headlines. Indeed, you might have read about this report in the newspaper or even watched it reported on the evening news.
But as well argue, the methods the researchers used to draw this conclusion are flawed, and that means that the conclusion that medical mistake is the third resulting cause of death is highly questionable.
When a report like this get broad media coverage, it can promote unwarranted mistrust of medication, which could prevent people from seeking needed care a concern to all persons who takes care of patients.
Whats wrong with the methodology ?
A medical error can be defined as a decision or action that results in patient harm and that experts agree “shouldve been” stimulated differently, given the information available at the time. But applying such a definition in reviewing patient records is fraught with difficulty.
The studys authors argue that demise certifications should be redesigned to recognize that more demises are attributable to medical fault. Thats a reasonable suggestion. But the implication of many media reports that these findings demonstrate hundreds of thousands of people are succumbing each year due to medical errors is highly problematic.
First, the authors of the Johns Hopkins report did not collect any new data. Instead, they based their conclusions on studies performed by other writers. There is nothing wrong with that in principle.
But in this case, the results are highly misleading because they are based on large extrapolations from very small data sets. The authors based their conclusions on four analyses that included a total of merely 35 demises attributable to medical mistake out of virtually 4,000 hospital admissions. Extrapolating from 35 demises to a population of 320 million is quite a leap.
In addition, these studies often do a poor job of distinguishing between adverse events and errors. They are not the same thing.
An adverse event is defined as any undesirable outcome after a drug or therapy is administered to a patient. Every medical test and therapy from antibiotics to surgery is associated with some risk of an adverse outcome. Adverse events can include demise, although that is rare. While every adverse outcome is regrettable, it does not prove that a mistake was built that based on what was known at the time, a medical professional should have made a different decision or acted in a different way.
Physicians typically cannot know in advance which patients will experience such reactions, so attributing such demises to error is misleading.
There is another problem with the Hopkins report: two of the four analyses it describes on use Medicare data, which is usually include patients advanced in years, in relatively poor health and being treated in the hospital. Sad to say, many such patients are at substantially increased risk of death embarking upon. Many will die during their hospitalization , no matter how well they are cared for. To attribute such deaths to error is to fail to account for the inevitability of death.
In fact, one of the studies on which the Hopkins report is based even includes a prominent correction factor. The author calculates the number of deaths due to medical error at 210,000. Then, based on the fact that the tools are used to determine mistakes are imperfect, the author chooses to double his estimate of the number of deaths due to error to 420,000.
The sort of medical chart review used in these studies is radically different from caring for patients. The uncertainty and stress associated with caring for the very sickest patients are often invisible to hindsight. Severely adverse patient outcomes are associated with a greater tendency to blamed person. When a patient has died, we want someone to be responsible, even if every action taken appeared justifiable at the time.
Other research suggests many fewer deaths from medical fault
This isnt the first analyze to try to assess how often medical mistakes can lead to demise. Other studies paint a very different picture of the number of deaths attributable to error.
In one responding to claims of very high death rates due to medical error, physicians reviewed 111 deaths in Veterans Affairs hospitals, attempting to determine whether such deaths were preventable with optimal care. VA patients are generally older and sicker than the U.S. population, and thus somewhat comparable to analyses based on Medicare data. Also, by utilizing optimal care, such studies may catch even more demises than the medical mistake standards, resulting in a propensity to overrate the number of deaths due to error.
At first, the researchers estimated that 23 percent of deaths could have been avoided. But when they were asked whether patients could have left the hospital alive, this number dropped to 6 percentage. Eventually, when the additional criterion of the three months of good cognitive health after discharge was added, the number dropped to 0.5 percentage. Preventable demises should be viewed in context, and there is a big difference between avoiding death and restoring good health.
Applying the rates from the VA study to U.S. hospital admission data, medical mistake would drop down to number 7 of the top 10 causes of demise in the U.S. Applying the additional criterion of three months of good cognitive health, medical error would not even rank in the top 20. Of course, doing so runs the same dangers as the Johns Hopkins survey; namely, extrapolating from a small study to the entire U.S. population.
To render a truly balanced account of medications role in causing death, it would be necessary to account not only for health risks but also the added benefit of medical care. Many patients with heart disease, cancer and diabetes whose deaths such studies attribute to medical mistake would not even be alive in the first place without medical treatment, whose benefits vastly outweigh its risks.
Looking at medicine from this point of view, we are fortunate to be living in an era of unsurpassed medical abilities, when the profession is doing more to promote health and prolong life than at any time in the past.
Perhaps the strongest evidence that such studies overestimate the role of medical error is that the fact that, when causes of death are ranked by authoritative organizations such as the U.S. Centres for Disease Control and Prevention, medical fault is not even included in the top ten. Would adding medical mistake to demise credentials change this? We doubt it.
There is no doubt that mistakes are available in medication every day, and if we take appropriate steps, error rates can be reduced.
But inflated estimates of the number of deaths associated with fault do nothing to advance understanding and may in fact make many patients more reluctant to seek care when they need it. A blinkered focus on mistake, without coinciding accounts of medications benefits, contributes to a distorted understanding of medications role in the area of health and disease.
This piece was coauthored with Jae Hyun Kwon, a student at the Indiana University School of Medicine .
Richard Gunderman, Chancellor’s Professor of Medicine, Liberal Arts, and Philanthropy, Indiana University
This article was originally published on The Conversation. Read the original article.