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Medical Errors Are Number 3 Cause of US Deaths, Researchers Say (npr.org)
An anonymous reader quotes a report from NPR: A study by researchers at Johns Hopkins Medicine says medical errors should rank as the third-leading cause of death in the United States -- and highlights how shortcomings in tracking vital statistics may hinder research and keep the problem out of the public eye. The authors, led by Johns Hopkins surgeon Dr. Martin Makary, call for changes in death certificates to better tabulate fatal lapses in care. In an open letter, they urge the Centers for Disease Control and Prevention to immediately add medical errors to its annual list reporting the top causes of death. Based on an analysis of prior research, the Johns Hopkins study estimates that more than 250,000 Americans die each year from medical errors. On the CDC's official list, that would rank just behind heart disease and cancer, which each took about 600,000 lives in 2014, and in front of respiratory disease, which caused about 150,000 deaths. Medical mistakes that can lead to death range from surgical complications that go unrecognized to mix-ups with the doses or types of medications patients receive. The study was published Tuesday in The BMJ, formerly the British Medical Journal.
People vastly overestimate how infallible people are (especially themselves). The rate at which humans make errors is about 0.5%. Which if you think about all the things you do in the course of a day, is a really big number.
About 7.3% of the population were hospitalized overnight or longer (23 million people).
If 250,000 of them died, then fatality rate due to medical errors is about 1.1%. Which is in line with the average error rate compounded over multiple ways in which errors could kill a hospital patient.
If you want to reduce the fatality rate, you either need to get people out of the system (e.g. autonomous cars - but they make people uncomfortable even though they're statistically safer), or implement automated checks to supplement people's work. We're already doing the latter with prescriptions - computers now automatically check for dangerous interactions between medications prescribed to the same person. More operating rooms scan all equipment used during surgery, and re-scans at the end to make sure it's all accounted for, and nothing has accidentally been left inside the patient. And some hospitals are starting to use barcode and RFID scanners to double-check that the medication being administered is the proper one for that particular patient.
I am an ER doctor and I can say that this occurs throughout hospitals throughout the United States every day. I have friends who work in emergency departments (ED) who have such bean counters tell them to see more patients and admit or discharge patients too soon. I work in an emergency department that does not have these bean counters yet but we do have "patient satisfaction" scores based on Press Ganey surveys. We are graded on how well we kept patient informed, spent time with patient, our friendliness, our skill, etc. Patients can score us from 1 (poor) to 5 (excellent) in 7-8 different categories. Most give us 1s or 5s and those that give us low numbers go on to state in the comments that "I didn't get a blanket, water, pain medication, etc" fast enough or "doctor didn't care about my condition". Mind you, most of these folks should not be in the ED in the first place and are at most urgent care patients. No one cares that you were tied up in the back with 4-5 critical patients who are trying to die on us and that we were busy for the past 2 hours to get them up into the ICU with the appropriate interventions made so that they will have a successful outcome. Instead, people are pissed off that you didn't take care of them right away for their symptom(s) or condition(s) and don't care that you (I) was busy elsewhere.
This is the reality of medicine in the United States these days. A doctor who must appease every patient (paying or non-paying thanks to EMTALA) as a waiter must his or her tables so that our patient satisfaction scores do not drop appreciably or else the bean counters will not be happy. if the bean counters are not happy, then you will be looking for another job.
If you want to be treated as a real patient, you better start looking for direct primary care physicians who take your money on a monthly or annual basis. In exchange they will give you their undivided attention in the form of hour long visits, communication via email, and your ability to reach them 24/7 as needed.
http://epmonthly.com/article/2...
A major portion of the money that is spent in the United States healthcare system is for end of life care. No one wants their elderly mother, father, grandmother, grandfather, etc. to die and wants "everything to be done" despite our recommendations that these interventions will not prolong their life. See http://khn.org/morning-breakou.... The emergency department is most likely the most efficient part of our health care system. See http://newsroom.acep.org/fact_...
Do you want treatment by a stressed out doctor, or no treatment at all?
False dichotomy.
There is more need than can be met by the supply of doctors.
Many other countries deal with this by having PAs and nurses handle routine cases, and only get a doctor involved if symptoms are unusual. Oh, and these countries have far lower costs and better health outcomes than America.
One should ask where is all the money going. It isn't going to the doctors. It is going to the parasitic medical establishment. e.g. the lawyers, the administrators, the FDA, the AMA, the insurance companies, etc.
If you want to solve the health care crisis:
1) eliminate the health care companies. We need direct pay!
2) eliminate the AMA. There are not enough doctors. Patients are dying in the emergency room waiting to be seen.
3) kill all malpractice lawyers. A doctor practising in good faith should never ever be sued
4) curtail the power of the FDA. The FDA does more harm than good.
Our current system has the doctors working for the hospitals, who work for the insurance companies, who work for the patient's employer. Can you see the problem? This is not how capitalism is supposed to work. It is no wonder health care costs have risen astronomically. The patient is only a very very marginal control over her or his health care and associated costs. It is all controlled by third parties who have a vested interest in not providing care.
There is no difference between big government and big corporations. You do not want you health care being run by the insurance companies or the government. Re-establish a doctor patient relationship with the direct pay system. It worked in the United States for 215 years. It can work again. Medical costs rose astronomically with the advent of wide spread insurance and malpractice lawyers. It used to be a few people fell through the cracks, now just about everyone falls through the cracks of the medical bureaucracy.
Direct Pay will save the day!
Disagree with me, you are probably a lawyer, or a medical industry bureaucrat.
My grandmother (on my mother's side) passed away about a decade ago after 'routine' heart surgery (no double or triple bipass). However it wasn't the heart surgery that got her, it was the infection after. The doctor's however had been 'confused' by her lack of progress and didn't believe she had an infection. At the same time I picked up on her having an infection after one visit and with no tests. She was never treated for an infection, though the autopsy proved that was the cause of death in the end. After that I truly understood why the US has such a high malpractice rate. The Doctor's had continued to rely on tests which told them the wrong answers and had so little time to actually see a patient that she was never treated properly.
In my own personal experience I had a diseased gall bladder since I was a teenager, however it went misdiagnosed for a decade and a half as IBS. However it finally got so bad that I couldn't function normally and for about the fifth time in my life I returned to the hospital to finally get a real explanation of what was wrong with me. When they removed my gal bladder the doctor who had performed the surgery had said it was the most diseased gal bladder he'd ever seen in a living patient.
All that money we pay for medical care seems utterly wasted between the insurance companies and the hospitals.
we are all invisible unless we choose otherwise
Trax, correct me if I'm mistaken, but I think you're referring to concierge style service, no? My wife and I signed up for this kind of service about a year ago, at a cost of $2k each. It's been night and day better than my old primary care. We get same day appointments, email responses (from our doctor) to medical questions, and it included the most complete (4-5 hour) physical I've ever been through, and additional time with a personal trainer and dietitian. For me, it's been well worth the cost.
Just another day in Paradise
Not to judge, but when I was having an appendicitis and thinking it was food poison searching on the internet gave me better control of the situation than the ED Doctor. He was so excited after the CAT Scan that it actually was an appendicitis and I was going to need surgery, rather than discharging me.
Point being we all have access to different information. As a patient, I didn't know how to filter relevant from non-relevant information. My pain was somewhat asymptomatic due to another problem that I didn't fit neatly into the right box.
I have know three other people who were discharged from the ED, only to be back an hour or three later when their appendix bursts. As a patient, you need to be your own advocate. The "guess what's wrong with me"game just doesn't work.
A friend's wife is senior management with a hospital system and we were talking about some of the impossible challenges of medical care and cost.
I kind of wondered if more opiates, doled out in small doses & quantities, wasn't actually partly the answer.
1) Pacifies the hypochondriacs and people with vague and poorly defined "symptoms" who end up getting a bunch of expensive tests to rule out rare conditions they don't have. They go home, feel better from the opiates and maybe find something else to be distracted about because they feel better. Eliminates a lot of doctor time, lab time and expensive time on limited access equipment like MRIs.
2) Masks symptoms in people who have chronic conditions and have no actual cure. These people may have expensive and marginally effective therapies for what actually ails them, but quite often these are expensive drugs, demanding physical therapies or other treatments that don't much improve their actual condition or how they feel and won't cure them anyway. A lot of the time is strikes me that these people are on expensive medications with weird side effects and marginal primary effects whose principal value seems to be they aren't opiates.
OK, there would be downsides, some of these people would develop low-level habits, but that's where the small doses and quantities part comes in. Given opiates under managed conditions, most would not spiral into raging junkies and many may actually experience an improved quality of life because they *feel* better. Even if they did have low-level, maintenance habits they could be on opiates for years without any significant side effects, and as drugs they are dirt cheap.
The up side is that a lot of people who clog the medical system with non-problems and conditions that mainly need to be managed to keep them living functional lives, probably saving a bunch of money and resources for people with treatable or more life-threatening conditions.
In a way, it's kind of a rationing of medical resources but with potential state-of-mind improvement for those rationed out of the system.