
Medical error is third biggest cause of death in the US, experts say - lemming
http://www.theguardian.com/society/2016/may/03/cause-of-death-united-states-medical-error
======
amalag
Just an anecdote: Our friend in New Orleans had his wife's second baby
delivery. They went to the same hospital and doctor as the first normal
delivery.

She was given the wrong medicine in the epidural. She went into a coma, the
hospital flew her to a specialty hospital in Denver to recover. Almost a year
later she is still paralyzed from the waist down. Her life is ruined, her
husband has two babies to take care of and an infirm wife.

The amazing thing is that the state of Louisiana has a $500k limit on
malpractice! (Set in the 1970's) Plus he will not get the full $500k. In spite
of their clear error the hospital will not just settle out of court. Instead
if they pay out through the court system they only have to pay $100k, the rest
comes from the state patient compensation fund which has $900 million dollars
stored up. So my friend will get $350k and medical care for his wife.

This is called keeping costs down in the state of Louisiana. And this was
affirmed in 2012 by their supreme court.

~~~
maxxxxx
The US needs a system where victims of malpractice get compensated but the
doctors or hospitals are not necessarily held liable (unless it's gross
negligence). US doctors spend a lot of time, energy and legal maneuvering
denying and covering up mistakes instead of being able to admit them and
improve procedures if necessary.

In my view there should be a nationwide malpractice insurance pool and the
medical associations should push for better quality standards within their
ranks.

~~~
cmiles74
I don't see why the the anesthesiologist should not be held liable in this
case (and possibly the hospital). In my opinion, it would be very reasonable
for them both to pay a significant penalty.

These abnormally low (and capped) penalties make it easier for those who
should not be doing this work to keep showing up every day. I understand that
we don't want to scare people in health care out of the field, but those who
are clearly inept certainly should be afraid to keep working.

~~~
calinet6
The problems are not inept individuals, nor will scaring people out of the
field improve conditions.

More than likely, the fear of recourse causes more error and malpractice than
the errors themselves.

Think for a moment: why are commercial airplanes so safe? Why when an airplane
crashes is it so rarely "pilot error?" And why, when it really is pilot error,
does the pilot not get blamed? It is because of profound realizations in the
design of the air travel system that veered toward systemic control of air
traffic and its safety, rather than individual pilot accountability.

I will say unequivocally and factually: our health care would be orders of
magnitude safer and higher quality if we treated it in exactly the same way.

~~~
rl3
Medicine would do well to learn from aviation.

Aviation safety is all about treating errors as facts of life, and erecting as
many barriers as possible between errors and a catastrophic outcome. When
errors do happen, everything is designed to trap them as early as possible
before they cascade into something worse.

There are compelling incentives (such as amnesty or leniency) for pilots to
self-report the mistakes they make. The entire industry has robust safety
reporting mechanisms, and virtually every non-trivial error is dissected in
reports for later study. When there's fatalities involved, you're talking a
full NTSB investigation.

~~~
eru
Google also has a robust `post mortem' culture. (Transporting the term back to
medicine where it came from might be a bit morbid, if used in the newly
acquired wider meaning of any analysis of failure after the fact.)

~~~
r00fus
In the Army (90s), we called them "after-action reviews" (AARs), for the
avoidance of highlighting morbid parallels.

------
noam87
As someone who's experienced the medical system for the past 6 years (family
and personal illness) and know many medical professionals, the level of
arrogance, ignorance and lack of professional integrity frankly borders on
criminal. It is _long_ overdue to shed light on this issue.

Good doctors are few and far between.

Stories of mind-boggling ineptitude are so common that my only advice is: if
you ever find yourself in need of medical care for anything major, your
_number one_ priority is to do your own research and micromanage your
physician at every step to ensure he doesn't fuck up. Or he will. Big time.
From the diagnosis stage to the treatment stage. Question his every decision
because your life depends on it.

Trust me when I say this advice could save you from so much pain and sorrow
many times over. I speak from experience. No not just one occurrence that left
me bitter, but seeing it happen over and over. Being in a position where your
life or the life of a loved one depends on people whose judgement you don't
trust can be really emotionally taxing.

I would go into specifics, but this is not an anonymous account. I can only
say in the medical profession, ineptitude and arrogance are the norm. The
stories you read in these threads, they are common enough that I've seen these
things happen again and again with my own eyes.

~~~
vgoh1
I see a lot of posts on this thread blaming overworked, tired, well-meaning
professionals that just can't do right, but I think you hit the nail on the
head. In my experience, arrogant pricks are just attracted to becoming medical
doctors.

I haven't gone to the hospital or doctors too much in my life, but every time,
I come away astonished at their attitude, and wondering how is it that people
can call a doctor a hero. When I went to the hospital to get my gall bladder
taken out, I was in the worst pain of my life. I needed pain killers, and
could hardly talk, and they spent 10 minutes getting my billing information
before a doctor would even see me. When the doctor finally game in, I wasn't
screaming or anything, even though I wanted to, just curled up in a ball, and
the doctor rolled his eyes at me like a teenage girl - I instantly became more
scared of being cut opened by one of these assholes than of the pain I was in.

Before this, I had been misdiagnosed several times - I had to figure out it
was my gall bladder from Google, and work hard to convince my doctor to even
explore the possibility it was my gall bladder. I had to TELL HIM that not all
gall stones are visible on an ultrasound. Before that, I had minor bladder
issues, which the doctors turned in to a major issue by constantly putting
catheters up me, and prescribing me several medicines to "see if they work"
even though they all said to not take if I was experiencing the exact same
symptoms that I had told them about.

I almost had a surgery for the problem - my doctor would always tell me that
the surgeon would discuss possible side effects before the surgery - I was
trying to get info at least days before the surgery, so I could sleep on it
and make an informed decision, but I wasn't able to talk to him until right
before they were going to put me under. When I continued to press him for
questions, he was huffing and puffing, like a teenage girl, any other grown
man would have been embarrassed to act like that. After pressing him, I
finally found out that a very likely side effect of the surgery would have put
me in a much worse situation that the problem they were going to fix - it
would have turned minor but annoying irritation into me needing to wear adult
diapers for the rest of my life! And he was visibly angry for having to tell
me that! Of course, I canceled the surgery.

I could go on and on, like how I was lied to about my bill, telling me it
would be around $250, but was really $2000, for tests that i didn't want, and
knew would come up negative, or how my daughter was born early but healthy,
and simply in the NICU for observation for 2 weeks, at $5000 a DAY, sitting in
an OLD incubator, with one nurse watching a few kids. I, for one, can't WAIT
until WATSON takes all their jobs.

~~~
adanto6840
I _very_ recently went to an ER, had absolutely mind-blowing levels of pain,
got in right away (the ETA #s shown live on their site probably went down,
that fast), only to be told I needed:

    
    
      -Brain CT
      -Cervical spine CT
      -3 or 4 X-rays
    

I asked how much a might cost, having no insurance -- to which the lady looked
at me like I was nuts; I just figured, hey, let's start with X-rays and go
from there... Her actual answer was "I don't know, I can call the billing
department if you'd like?" I was partially embarrassed, mostly just in pain,
and frankly ready for some actual guidance/help. I basically just said "Okay,
whatever, go go go, figure out what is wrong with me now!". No idea what it'll
have cost yet, I'm putting the over/under at $3.4k though, heh.

I ended up leaving in more pain than I arrived in; after I suggested some
possibilities based on Google they, seriously, looked it up on YouTube
including how to test me for it (TOS / Thoracic Outlet Syndrome), then
proceeded to give me an injection of muscle relaxer which didn't help at all,
and then released me. I'd have been better off taking another 4-8 ibuprofens
at home.

Thankfully I do actually have a fantastic, dedicated, caring, highly
intelligent doctor who I saw right away on Monday -- severely herniated
cervical disk (MRI imaging is amazing BTW).

Idk if I look like a drug junkie or what, but that was one of the worst days
my life for both myself & my wife.

------
mikestew
Every time someone in the medical field tells me about how dangerous
motorcycles are, I remind them of the woman I knew (world-class rider in some
aspects of the sport) who was in a motorcycle crash. The crash didn't kill
her, the people giving her the wrong drugs did.

Years later I read _The Checklist Manifesto_, only to be horrified that not
only did medical personnel need to be _told_ to use checklists, many resisted
the idea. It's one thing to kill people because of a mistake, we all make them
and thankfully the ones _I_ make usually don't get anyone hurt. But it's quite
another to kill someone because your industry is one step ahead of using
leeches. I mean, suppose I make a commit that rolls into production and takes
out production data. Someone asks, "did you follow the checklist?" If I say,
"yes", it's unlikely that heads will roll and we'll update the list when we
find out what went wrong. But if my answer is, "no. In fact, I don't even have
a checklist/documented procedure, I just make sure my commit message is
informative and hope I remembered everything", I'm likely to get fired. A
doctor does it, shrugs it off with "we did everything we could", and a lot of
time we all just go on about our day.

~~~
sopooneo
I can not think of a single good reason to avoid check-lists in the medical
field. And the doctors who resist them may very well just be arrogant and
elitist. But there may also be some other reason. I don't know because I'm not
a doctor, but I do know there are always things I don't know to consider in
unfamiliar fields.

Do we have any doctors on the board who could explain a _defensible_
resistance on the part of doctors to using checklists?

~~~
leonth
I am not a doctor, but I do have several practical defenses (I don't want to
go through political ones).

There are many business processes in the healthcare field, and the impact and
ease of imposing checklists will be naturally very different for each:

* Diagnosis and treatment protocols / pathways - these span long periods of time (days to months), any checklist will probably be quite complex and redundant to the already existing longitudinal case notes.

* Procedures (like surgeries) - some parts like preparation can be subject to checklist. But the procedure itself may need >= 2 clean hands and good concentration, thus glancing over checklists multiple times during procedure, or worse attempting to tick off stuff might cause more harm than good. (don't tell me to add one more guy there - we need him to save another patient, and google glass is dead for now)

* Processes related to ordering, dispensing, and administering medicines: there are probably tens/hundreds of thousands of these processes happening in a hospital at any given day. If a checklist introduces speed penalty it will be rather burdensome for the facility (and patients too). Furthermore, an equivalent of a checklist (e.g. refusing to proceed unless certain required fields are filled) has usually been codified in the hospital systems being used. Also, I feel that adding a checklist for something that you do hundreds of times a day, will not achieve anything, because the muscle memory will take over - you will just do things as per usual and sign off "all done" on the checklist, because you always do them all the time whether you remember or not, right?

~~~
petra
>>>Diagnosis and treatment protocols / pathways

Even with what you say, clinical decision support(which can be viewed as an
automated system of double checking) have shown to lead to better care.

~~~
leonth
I completely agree, although the attitude at facilities where this has been
done extensively is always "how can we reduce the alert/popup/notification
burden" because it always invariably slows things down and annoys people. And
after a while the muscle memory stuff comes in as well - a typical alert can
pop up tens of times a day with very high false positive rate.

An automated "checklist generation" is easy via subscription to data vendors,
whereas manual curation takes years (even when only codifying best practices).
And we can't just have one set of alerts for the world because everyone's
(patient demographics, risk appetite, clinical sophistication level, computer
skills, political situation) is different.

~~~
petra
>> And after a while the muscle memory stuff comes in as well - a typical
alert can pop up tens of times a day with very high false positive rate.

Do the best tools able to solve this in a satisfactory manner(the tool issue,
the organizational issue) ? How ?

>> whereas manual curation takes years (even when only codifying best
practices)

Can't this be done in parallel ? and why are resources an issue for such an
important thing with a clear health ROI and maybe financial ROI ?

~~~
leonth
> Do the best tools able to solve this in a satisfactory manner(the tool
> issue, the organizational issue) ? How ?

The best solution is I believe relentless continuous manual curation, which is
discussed below. Automated tools are rather frowned upon in this area because
I don't think there is any that is good enough until everyone is comfortable
to rely on the black box.

> Can't this be done in parallel ? and why are resources an issue for such an
> important thing with a clear health ROI and maybe financial ROI ?

It definitely can be done in parallel. It takes years mainly due to political
issues - like doctors arguing against each other which treatment/alert/option
is the best, doctors/nurses/pharmacists arguing against each other who needs
to look out for certain alerts, etc. We are not talking about tens of alerts,
the number usually comes up to thousands.

Resource is an issue here because the best people to manually curate are the
healthcare professionals themselves, but they are usually, you know, treating
patients, so they are hard to find on their desks. And as mentioned elsewhere,
the industry is highly hierarchical, so a bunch of minions can propose changes
to alerts but everything needs to go to some higher authorities because the
stakes are too great. Sometimes this "higher authority" does not decide
without a formal consultation with some other authority. (nobody wants to be
blamed if an error happens because the hospital just removed a perceived low-
quality alert a week ago)

Coupled with the need to perform lots of research to produce high quality
alerts, I would presume only large-ish hospitals / clusters (perhaps > 1000
combined bed capacity) can afford full-time people to look into this.

~~~
petra
Thanks for the detailed response.

So it's hard to get the resources in a single hospital, what about
collaboration across hospitals or even the department of health ? Seems like a
worthwhile goal.

------
jobu
Often the medical errors happen on very common procedures like central-line
catheters or IV insertions. Staff are overworked and tired, or they get
distracted and miss one step and it results in a patient blood infection and
often death.

John's Hopkins came up with a five-step checklist for central-lines that
reduced overall hospital deaths by 10%
[http://www.hopkinsmedicine.org/news/media/releases/safety_ch...](http://www.hopkinsmedicine.org/news/media/releases/safety_checklist_use_yields_10_percent_drop_in_hospital_deaths)

~~~
flubert
>Staff are overworked and tired

Yes, I wonder if anyone has studies the medical error rate as a function of
how many hours the provider has worked previously that day, and the time of
day. One thing I found crazy was that nurses were working three 12-hours
shifts per week, but then there was overtime. This might be okay for a 7AM-7PM
shift, but what about the 7PM-7AM shift? What if they changed to five 8 hour
days instead? How would that effect the error rate?

~~~
cloverich
The Catch-22 there is that a majority of medical errors occur during shift
changeover. (Google will reveal an abundance of commentary / articles). In my
personal experience (Medical school) the shift change's amongst Doctors could
occasionally be profoundly short, unprofessional, and unregulated (think
Resident handing off to Intern, in a rush, late in the evening, using a some
notes hastily written on a notepad).

~~~
smileysteve
Importantly, changeovers often happen _AFTER_ a 12 hour shift - makes it hard
for this to directly causal of the changeover vs the tiredness.

------
rayiner
Estimates peg the cost of preventable medical errors at $100 billion-$1
trillion per year: [http://www.wolterskluwerlb.com/health/resource-
center/articl...](http://www.wolterskluwerlb.com/health/resource-
center/articles/2012/10/economics-health-care-quality-and-medical-errors).
Applying the methodology of this article to the estimate (250,000 deaths per
year) in the Guardian piece, yields an economic cost of death due to medical
error of about $250 billion.

Ironically, the recent debate has centered on "defensive medicine" which
posits that doctors are too careful because of malpractice claims. But the
estimated costs of premature death due to medical error dwarf the estimated
costs of defensive medicine, about $50 billion per year:
[http://medicaleconomics.modernmedicine.com/medical-
economics...](http://medicaleconomics.modernmedicine.com/medical-
economics/news/defensive-medicine-balancing-act?page=full). In fact, the data
suggests that doctors and hospitals are _not careful enough_.

~~~
cloverich
"Defensive medicine" is a common defense but, in my limited personal
experience I don't think it is valid. Doctors who know (and follow) the
guidelines never seem to say anything about Defensive medicine; Doctor's who
seemed to either not know them as well (or just not know what they were doing
as well in general) were _constantly_ bringing up defensive medicine
complaints. Its also interesting to note the many of the tests you order come
with an interpretation provided by another physician. So, a Doctor (esp.
resident / intern) who is unsure of themselves will often order unnecessary
tests as a way to consult with other Doctor's (it is, process wise, far too
difficult to simply say "I don't know" and get help).

~~~
venomsnake
Defensive medicine is prescribing antibiotics for viral infection when the
patient obviously does not need them, but he insists taking them to feel taken
care of.

------
hotpockets
Makes me wonder why there's no war on medical errors. Humans are weird. We've
evolved to fear most our prehistorical number one threat: other humans. This
leads us to waste so much money and to continue sacrificing our own children,
spouses, and relatives.

~~~
rictic
Interesting blog post on the subject: [https://blog.jaibot.com/foes-without-
faces/](https://blog.jaibot.com/foes-without-faces/)

~~~
hotpockets
Very apropos link. Thanks for digging it up.

------
viraptor
Does anyone know the actual paper/study link? Pubmed knows nothing,
researchgate has some interesting safety-related articles
([https://www.researchgate.net/publication/301685868_Surgeon-L...](https://www.researchgate.net/publication/301685868_Surgeon-
Level_Variation_in_Postoperative_Complications)) but nothing about
errors/deaths that I could find.

NVM, it's here:
[http://www.bmj.com/content/353/bmj.i2139](http://www.bmj.com/content/353/bmj.i2139)

------
bawana
You mean the health care sector has gotten so good at fixing all the other
causes of death that what we see is the 'noise in the system'?

I think not. You cannot legislate good care on the backs of physicians. Or
physicians will go on strike just as they did in the UK last week. In 3 days,
40,000 surgeries were cancelled. 80,000 office visits cancelled. But the PR
people were quick to get on the tube and with their constipated smiles
reassure the public that there were no problems. How many of those people
died? We'll never know.

In the US, as long as insurance executives cut physician payment in favor of
hospital bureaucracies and executive compensation, HMOs pile on the
regulations to reduce utilization, physicians are slammed left and right to
guess what's right instead of doing the necessary tests- there will be
progressively LESS quality care. Checklists do slow down care delivery AND
they are insufficient. Errors snowball because a sick patient is like a set of
dominoes ready to topple. Just because the surgical site was properly marked
and the type of operation was verified, does not mean that the patient will
not fall off the stretcher when 5 people have to struggle to move an inanimate
pile of flesh from the operating table to the gurney. The more people involved
in a given endeavor, then the likelihood of error increases. We need to strive
to simplify care, not complexify it.

We have already shipped many of our manufacturing jobs overseas. At this rate,
much of our medical care will go the same way. The upper echelons of the the
insurance companies and the HMOs will enjoy their views of the New York
skyline while they figure out how to outsource health care to Cuba.

We also need transparency on costs. Once we get the REAL data, improvements
will inevitably follow.

We also need REAL data sharing. There are 453 electronic medical record
systems now in the US and they don't talk to each other. 453 versions of
'microsoft-like behavior' obscuring the flow of information. It's too funny to
think of HIPAA in an era when the NSA already knows everything. And people are
always blabbing about their health problems anyway. Just stand in line at
Panera, Starbuck's.

------
bradleyjg
If someone has terminal cancer, gets palliative surgery, the surgeon makes a
medical error, and the patient dies on the table has he died of medical error
or cancer?

For this reason deaths caused isn't the best metric. It would be better to use
QALY (quality of life adjusted years).

~~~
epoxyhockey
_the surgeon makes a medical error, and the patient dies on the table has he
died of medical error or cancer?_

Medical error. Just because the patient was going to die sooner than later,
does not erase the fact that a medical error was committed.

Quality of life is a completely different topic, in my opinion, and I am sure
we would find more common ground in that discussion.

~~~
jessriedel
> Quality of life is a completely different topic, in my opinion, and I am
> sure we would find more common ground in that discussion.

You don't understand why bradleyjg brought up QALYs.

~~~
mariodiana
If you can spare the time, it would be a mitzvah to give us a thumbnail
sketch.

~~~
jessriedel
The point wasn't to highlight the distinction between low-quality life and
high-quality life per se. (That's a separate issue, as epoxyhockey said.) The
point was only that the badness of an accidental death, and the cost we might
be willing to imposed to reduce them, should probably reflect that
counterfactual where no mistake occurs. QALYs lost are one way to measure the
badness of a death, but he could have also just said "expected days of life
lost".

Of course, epoxyhockey's would likely still disagree.

------
kiloreux
I lost my father at a very young age (I was 14) because of a medical error,
and we had to go through a lot of things to keep food on the table, now as
much as I think the US system might has more justice than my country, where
the doctor is still working and we never got compensated 1$ for such death, I
wish that never someone goes through the things we have passed through because
of a horrible medical error.

~~~
fiatjaf
I'm sorry.

------
timmytokyo
One way to improve the situation is awareness. The Leapfrog group has
established the "Hospital Safety Score" web site to check a hospital's safety
"grade" based on publicly available information. Punch in your zip code and
examine all the hospitals near you. The next time you or a loved one needs to
go to a hospital, only choose among those that received an A. If enough people
start doing this, the hospitals with lousy safety practices will start to get
the message.

[http://www.hospitalsafetyscore.org/](http://www.hospitalsafetyscore.org/)

------
Shivetya
I learned this lesson through my boss who passed away awhile back after years
of liver problems. If you want to survive complicate or life threatening
health issues you need to learn as much as you can about what your treatment
options are, which medicines are safe, at what dosage, and in what
combinations.

My favorite story was his stopping a nurse from administering 700 units of a
medicine that in that volume would have killed him. The doctor had written 200
but the bottom of the two landed on the line of the form near perfectly.
Fortunately the nurse went to verify and he made it out that time

~~~
Unklejoe
It's amazing that prescriptions are still being hand written these days.

~~~
mariodiana
It's amazing that my bank asks me to write amounts both longhand and in
numerals when writing a check, even in amounts as small as a dollar, but that
doctors scribbling out dosages of medications that can easily kill people has
been standard operating procedure since the whole thing started.

------
Alex3917
For what it's worth, I have a lot of stats here that put this into context and
also provide some good additional reading:

[http://www.alexkrupp.com/Citevault.html#iatrogenic](http://www.alexkrupp.com/Citevault.html#iatrogenic)

(And yes, I know this could be made much more readable with some basic CSS,
I'll get around to it eventually.)

~~~
DINKDINK
Iatrogenics needs to be discussed more, thank you for your contribution
regarding this topic

------
jayess
250,000 people a year are killed by medical mistakes. 11,000 are killed by
guns. So you're 22 times more likely to be killed by a medical professional
than someone with a gun.

In fact, since there 19,000,000 medical industry employees in the United
States, and 300,000,000 guns (and probably somewhere around 100,000,000 gun
owners), you have a 1.3% chance of a medical professional killing you and a
0.01% chance of a gun owner killing you.

~~~
bainsfather
I think you mean: "A medic has a 1.3% chance of killing _someone_ this year".

------
shivpat
This is a weak analysis.

"To determine the medical error death rate, the researchers analyzed data
collected by the government and compared it with hospital admission rates from
2013. They extrapolated that information and found that 251,454 deaths in the
US were caused by medical error that year."

~~~
uslic001
The way they guessed this completely made up number and the fact that it is
being reported as real is sad. I can count on one hand the number of deaths
caused by medical errors I have seen in my 25 years in medicine. Most errors
do not lead to any morbidity or mortality. If this was a real number every
person would have numerous relatives that had died due to medical errors. This
is not the case. These fanciful fear mongering reports do nothing to reduce
medical errors.

------
Roboprog
#include std_disclaimer.h

I work on the team that maintains the CA Electronic Death Certificate System.
Yesterday, our supervisor sent this out among the team.

The certificates have spots for immediate and contributing cause of death. We
are working on a system for doctors to enter this information (tie in our
system to the hospital's) while it is fresh in mind for the staff, and to
gather the info in near real time for NIH after finalization.

However, even as a programmer, I think it is harsh to expect a doctor to self
critique himself/herself in that position (assuming he/she were so inclined).
As one of the commenters on one of the articles about this study pointed out,
it used to be automatic that a death in the hospital went to the coroner. This
would allow a somewhat neutral, educated, third party to asses for procedural
errors and the like.

Are we, in the continuing age of Reaganism in the US, ready to budget for that
sort of backstop to find, analyze and correct these kind of problems?

------
jonwachob91
So... No mention of the different errors that occur and lead to these deaths?

A quick look on the CDC site indicates about 70k a year deaths from infections
acquired in the hospital (HAIs), but other very reputable sources point
towards 100k deaths a year.

What medical error committed is not trivial, and should be listed. Not all
procedures carry the same risk.

------
gshulegaard
Possibly a horrible finding, but this line makes me skeptical:

> They extrapolated that information and found that 251,454 deaths in the US
> were caused by medical error that year.

I would be interested to see their methodology, but it sounds tenuous.

~~~
TallGuyShort
My first thought was the likelihood of dying from something that was
misdiagnosed or not caught in time. That could be considered medical error but
is a whole different ballgame from, "they accidentally prescribed cyanide."

~~~
TallGuyShort
However, their point is not about assigning blame, it's about tracking how
many deaths could possibly have been prevented by improving the system rather
than ignoring everything but diseases that put people in the system. So now
that I think about it, it makes just as much sense to track and improve
misdiagnosis just as much as mistakes in the pharmacy...

~~~
cfmcdonald
Surely then it should not be framed as people "killed by medical errors", but
rather people who could be saved by improving medicine.

The way this is framed in the media is especially absurd, calling it the #3
cause of death after heart disease and cancer. Many of the deaths in question
certainly were from heart disease and cancer. They are not disjoint
categorizations.

------
phogel
I've spent years building systems that validate human action/decision in a
clinical context (giving meds, transfusing blood, etc.). The environment is
error prone and the technology in place is disparate and often operates on
incomplete information. It's ripe for automation/optimization.

It was scary to see how quickly a new safety feature stopped a potentially
catastrophic error.

[http://www.patientsafesolutions.com/patienttouch-clinical-
wo...](http://www.patientsafesolutions.com/patienttouch-clinical-workflows)

------
erikb
I hope it becomes first one day. Think about a world where our medicine is so
good that most other causes of death aren't as severe. Then the only serious
thing left is some margin of human error. And even that may decrease as the
technological support improves.

------
ndesaulniers
> There is no US system for coding these deaths

Because admitting to malpractice would be admitting guilt.

------
davidw
How does this compare to other countries?

------
ilamont
The older I get, the more stories I hear involving friends or relatives
subjected to poor medical care or advice. The case that leaves me shaking my
head involves a friend who had a surgical sponge left inside his leg during a
procedure which almost led to his death some months later.

When it comes to errors resulting from misdiagonses: An experienced doc/med
school professor once told me that they are unable to diagnose 10% of cases
that come to his hospital (i.e., don’t know the cause of the
ailment/symptoms).

------
droopybuns
These kind of stories make me feel like the medical & insurance industry has a
strong undercurrent of corruption that people are reluctant to address.

------
joesmo
Considering how often healthcare professionals work without sleep is this
surprising? Nothing short of ordering sleep and preventing professionals who
haven't slept from working will really put a dent in this problem. And the
only thing that will get this done is regulations. Until then, people will
continue to die and others will continue to push against regulation killing
people in the process.

------
throwaway049
I recommend this lecture "Designing IT to make Healthcare safer" by Professor
Harold Thimbleby as being of interest to people on here. There's a video and a
transcript.

[http://www.gresham.ac.uk/lectures-and-events/designing-it-
to...](http://www.gresham.ac.uk/lectures-and-events/designing-it-to-make-
healthcare-safer)

------
et2o
In this thread: people who have literally no idea what they're talking about
spouting off.

I hope it isn't this bad when I read things about other fields.

~~~
mej10
That is a basic tenet of the computer career personality.

They've been rewarded for how smart they are their entire lives, so they think
they can understand things completely by reading a few paragraphs about it.
Even worse if they have one life experience that somehow totally justifies
their view of an entire field that varies _dramatically_ from provider to
provider.

It is the same reason every software person living around SF thinks they are
economic geniuses because they got rich by being lucky.

The anecdote about a motorcyclist bringing up a medical error causing a fellow
motorcyclist to die -- as if this somehow makes riding a motorcycle safer?
What the actual fuck.

Spend a few days observing a large trauma ICU and they will rethink their
story about motorcycles. People have no fucking idea.

------
kazinator
What is the algorithm for deciding, in every case of death, whether it was
"medical error" or something else?

------
givan
I don't understand why there is no good rating system for doctors, we have it
for restaurants, hotels etc but not for doctors?

Yes doctors are more complex but the rating system can be improved over time
by feedback and observation and this system can help filter out the doctors
that became doctors mostly for financial reasons.

~~~
uslic001
Because most patients rate doctors based on whether they were given what they
wanted rather than if what they did was medically correct. If you fail to give
a patient a pain medication or an antibiotic you get a bad review even though
it was the right thing to do.

------
et2o
Honestly I can't imagine this being possible. They must use an extremely broad
definition of medical error.

------
AzzieElbab
Having worked in health care IT in the US and Canada, all I can recommend is
'do not get sick'. Even if the data is right, there is a 50/50 chance medical
practitioner will misread or ignore it

~~~
greedo
My GP blew a diagnosis that should have resulted in my early demise. He took
down my symptoms without doing an exam (duh) and then a year later decided,
yeah, maybe that colon cancer isn't a hemorrhoid... Only reason I'm still here
is pure luck and the grace of God.

------
ransom1538
Doctors routinely avoid questions: "How many times have you performed this
procedure." This question COULD save your life. Always ask. Experienced
doctors will give you a hint through body language. Younger doctors will
become nervous and avoid any questioning. If you are told there will be
another doctor assisting: AVOID.

Shameless plug: I am committed to fixing this. IF you want to join me let me
know. [https://www.opendoctor.io](https://www.opendoctor.io)

------
DyslexicAtheist
Nassim N. Taleb touched on this in Black Swan and even more aggressively in
_Antifragile[1]_.

[...]

 _Overtreatment of illness or physical problems, he suggests, can lead to
medical error, much the way that American support of dictatorial regimes “for
the sake of stability” abroad can lead to “chaos after a revolution.”_

[...]

[1] [http://www.nytimes.com/2012/12/17/books/antifragile-by-
nassi...](http://www.nytimes.com/2012/12/17/books/antifragile-by-nassim-
nicholas-taleb.html)

------
PerfectElement
A while ago I was watching a great talk by Dr. Greger [1] where he listed the
top 10 causes of death and how to prevent them. I remember being surprised
when I saw "doctors" listed as a leading cause of death. I don't remember what
his advice was on how to prevent doctors, so I'll have to watch it again.

[1] [https://youtu.be/30gEiweaAVQ](https://youtu.be/30gEiweaAVQ)

------
briantakita
Iatrogenesis -
[https://www.wikiwand.com/en/Iatrogenesis](https://www.wikiwand.com/en/Iatrogenesis)

I learned about this concept in [http://www.amazon.com/Antifragile-Things-
That-Disorder-Incer...](http://www.amazon.com/Antifragile-Things-That-
Disorder-Incerto/dp/0812979680)

------
schizoidboy
It would be fascinating to work towards reducing this problem. Any thoughts on
how to get into this field or how software could be applied?

~~~
ashearer
A major aspect is miscommunication. According to the Joint Commission:
"Ineffective hand-off communication is recognized as a critical patient safety
problem in health care; in fact, an estimated 80% of serious medical errors
involve miscommunication between caregivers during the transfer of patients."
[1]

I co-founded Care Thread [2] to help address the communication problems I saw
working in hospitals. Electronic medical records systems weren't designed
around real-time communication, and mobile secure messaging systems tend to
replicate the original alpha pager workflow, without directing the improved
technology at improving collaboration.

The project involves removing points of communication friction, keeping track
of the patient's care team, injecting relevant EMR data into the
communications stream and pushing it to the right care team members as soon as
it's available, and keeping everything visible to the interested parties.

If you're interested in something like this, I'd love to talk. Please contact
me through my profile or on our web site.

[1]
[http://www.jointcommission.org/assets/1/6/tst_hoc_persp_08_1...](http://www.jointcommission.org/assets/1/6/tst_hoc_persp_08_12.pdf)
[2] [http://www.carethread.com](http://www.carethread.com)

~~~
alon44
Hi ashearer, I work with the Patient Safety Movement Foundation and just sent
you an email through your demo@ email address. Looking forward to connecting
with you.

------
djyaz1200
This is a problem technology could dramatically reduce if each of us had a
complete medical/medication history that was immediately accessible to the
physicians/institutions treating us. That doesn't exist now unless you're
getting all your treatment/meds from one company/hospital system (Ex: Kaiser).
Right now if you (or your spouse/kid) are brought to the ER unresponsive the
doc isn't going to know shit about what meds you are on, what you're allergic
to or perhaps even why you're unresponsive in the first place... in the case
that they do have information it is likely incomplete. It's not the slightest
bit surprising this routinely leads to bad outcomes because doctors are
guessing. Dr. William Yasnoff (MD & PhD Computer Science) has suggested the
concept of "Health Record Banking." Similar to financial banking institutions
would compete for the right to host your health data and providers could
"withdraw" records and "deposit" records. Your smartphone would be a key
portal to access this information securely. I'm not sure what the perfect
solution is here but the Hacker News crowd is going to have to be the folks to
fix this because government, doctors and insurance companies are not.

~~~
akerro
>This is a problem technology could dramatically reduce if e

This problem doesn't exist in 2nd and 3rd world countries and didn't exist in
US two decades ago.

~~~
djyaz1200
I'd say this issue gets more severe as the complexity of care delivered
increases. The more providers, docs, meds are thrown in the mix the more
likely it is that there will be an error. If each of us had realtime records
when the doc ordered a medicine we are allergic to their computer system could
have a fun little pop up like the Microsoft paperclip guy that said "Hey,
looks like you're trying to kill this patient by administering a drug they are
allergic to press ok to proceed or X to cancel.

------
perilunar
The comparison between Medicine and Aviation has been discussed here before:
How mistakes can save lives: one man’s mission to revolutionise the NHS
(newstatesman.com)
[https://news.ycombinator.com/item?id=7865917](https://news.ycombinator.com/item?id=7865917)

------
alyx
Anybody know of any good self-help/research communities or forums?

Search engines are filled with clickbait these days.

------
twoarray
In other places, it's even worse:

[http://gawker.com/5954179/when-oopsies-leads-to-death-
studen...](http://gawker.com/5954179/when-oopsies-leads-to-death-student-
nurse-who-injected-patient-with-coffee-argues-anyone-can-get-confused)

------
Gatsky
Lot of sad stories here, along with understandable mistrust of doctors.
However, the most outrageous point thst emerges from the article is that in
the US nobody is even measuring the rate of medical error. That is a criminal
failure at the government level.

------
BurningFrog
I'll just point out that what is the "Nth biggest cause of X" is entirely
dependent on what classification scheme you've chosen for causes of X.

The article is better than most in pointing out that it's 9.5% of all deaths
in the subheadline.

------
nwah1
Robotic surgery has way lower error rates, but people are so scared of
anything new.

~~~
haldujai
This is blatantly incorrect. All of the latest evidence suggests that robotic
surgery is not associated with clinically (or even statistical in many cases)
significant improvements in patient outcomes when compared with other
minimally invasive techniques (laparoscopy), currently the only field where
robotics may have some benefit is in urology and even then, it isn't all that
clear. Robotics have clinically significant improved outcomes only when
compared to open procedures.

No one is scared of robotics but it costs the hospital a lot more money to run
the DaVinci system and it requires significantly more OR downtime to prep
between cases reducing OR utilization and the number of cases you can do.

Robotics may one day be the answer but not yet.

1\.
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254844/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254844/)
2\.
[http://link.springer.com/article/10.1007/s00384-016-2516-7](http://link.springer.com/article/10.1007/s00384-016-2516-7)

~~~
nwah1
But that's just it. For instance, the FDA just the other week denied approval
to a hopeful competitor to DaVinci, called SurgiBot. This is preventing
competition from driving costs down. Hopefully the big new entrants, Johnson &
Johnson in partnership with Google, will have enough clout to shake things up.

It is not only difficult to bring new products to market, but also difficult
to improve existing products. The 510k application process is claimed to be
getting less onerous, but yet it still takes over a year to get a decision
after submission.

It's just hard to get anything out there in our highly regulated, litigious,
and fearful society. The rapid iteration that we like to see in tech can't do
its magic in this environment.

------
slr555
This statistic gets bandied about every now and then and is completely
indefensible. Extrapolation is hardly proof and the CDC statistics don't begin
to validate this nonsense.

If it were true it would mean that for essentially every person you had ever
heard of dying from any type of accident or pneumonia there would be one
resulting from medical error.

Every fatal car wreck you ever read about. Every drowning. Every fatal
accidental shooting or fall AND every person you had ever heard of dying from
lower respiratory tract infection would have an approximately equal number of
deaths CAUSED by medical errors.

In other words people who would have lived instead died because a medical
professional made a mistake.

If you believe that's true I have a wonderful bridge here in Brooklyn I would
be happy to sell you for a very reasonable price.

------
felix_thursday
So, does this mean people are more okay with giving Google all that NHS data
now?

~~~
brent_noorda
So "googling" our personal health data would serve the doctor 40% google ads,
50% bait, 9% invalid information put there by some crackpot, and 1% (buried in
there somewhere) of actual valid data?

------
MaPaAbCa
Does anybody has world breakdown figures for medical error, please?

------
shirro
Medicine and road transport are two areas where I hope AI can save us from
ourselves because both produce a huge public benefit but they are both
hopelessly prone to errors with deadly consequences.

------
pascalxus
Another side effect of Medicare and Medicaid overfunding. According to AARP,
people are getting way too much medical care - to many surgical diagnostics
and procedures putting people at increased risks.

~~~
maxerickson
Medicare pays less than any private insurer.

Medicaid pays less than Medicare.

------
known
[https://en.wikipedia.org/wiki/Second_opinion](https://en.wikipedia.org/wiki/Second_opinion)
should be made compulsory

------
spectrum1234
Didn't read the article but this could be a very good thing. It could mean
that health care is extremely good at saving lives so the only thing left is
error.

------
desireco42
I think we need WAR ON MEDICAL ERRORS ! ! !

:) Joking of course. But anything else would require us to address the
problem.

------
tn13
Shallow journalism by Guardian. More access to medical care means more people
go to hospitals and live longer and hence there is a good chunk of deaths that
were preventable if doctors or hospitals did better. This is not same as
saying 'Doctors are killing people'.

The correct way to judge this number would be to see what % of people have
access to medical care.

------
fiatjaf
Well, this is a problem created by the State and its medical licenses.

At the time anyone with a medical license is just a doctor as anyone else,
because they all have the same license, disappears the need to show your
potential patients that you are indeed a doctor that cares about quality.

------
bitL
An opportunity for automation and for MDs to take more rest...

------
nxzero
This isn't news, nor is the fact that people refuse to except that medical
professionals are not prefect. Both the patient and medical communities are
responsible for fixing the issue. Until that's the case, this will always be
an issue.

------
0xdeadbeefbabe
I ate too much. Is that the first cause of death in the US?

------
ythl
It doesn't mention what #2 and #1 are, but based on the amount of attention
gun control gets, I'm assuming guns are either the #1 or #2 killers.

~~~
cpncrunch
The article itself says cancer and heart disease are #1 and 2.

~~~
ythl
Yeah but america has a __huge __gun problem so I 'm assuming it's in at least
the top 5.

------
good_sir_ant
Good to know medical licensing is there to ensure our well-being, in addition
to streamlining the entire medical marketplace.

/s

------
wodenokoto
Something has to be the biggest, second and third cause of death.

In a perfect society,what is the number one cause of death?

------
hNewsLover99
Interestingly, but not surprisingly:

1) Like the hundreds of comments attached to this post (or at least the ones
that I have read) today's mainstream media coverage of the Johns-Hopkins study
(or at least the reports that I have seen) omits the study's admission that it
understates the total "medical error homicide rate" (SEE NOTE 1 BELOW) (by not
including similar fatalities at nursing homes, outpatient clinics and other
non-hospital settings).

2) As a result, most people who viewed that coverage now incorrectly believe
that annual medical error homicide rate is a paltry 250,000, when in fact it
has previously been estimated to be nearly twice that number. See, e.g., the
2013 study reported by HuffPo, in which the total figure was estimated in 2013
to be over 440,000. (SEE NOTE 2 BELOW.)

That's like losing the 50,000 U.S. soldiers lost during the ten-year long Viet
Nam War every six weeks, month after month, year after year, decade after
decade.

3) A condition imposed by the hospitals submitting to studies of this sort is
that findings of error cannot be disclosed to the victims' surviving families
or legal representatives (who, of course, are legally authorized to access the
victims' patient records, and to assert claims on behalf of their estates).
Stated differently, the medical profession can be induced to examine its
inadequacies only if it is first favored (bribed?) with perpetual immunity,
anonymity and concealment.

4) It is unknown (or at least unreported) what percentage of medical error
homicides: - Are ever disclosed to surviving families, - Lead to professional
conduct investigations, and to sanctions, - Lead to claims or suits, - Go
uncompensated, or unfairly under-compensated, or - Are fairly compensated,
both before and after legal fees and expenses.

5) As a result we cannot know the size of the economic windfall enjoyed by the
perpetrators of these homicides, their stockholders, and their liability
insurers.

6) But we can make some rough hypothetical calculations. If, for the sake of
argument, half of the families of the 250,000 (or more likely 440,000) annual
victims of medical error homicide were reasonably entitled to a $2 million
(gross) recovery, but received nothing, then the annual saved-liability
windfall would be $250 billion (or, more likely, $440 billion). Year in, and
year out...

7) If the true economic costs of medical error homicide, of fraudulently-
evaded civil compensation for victims' families were ever known, perhaps a
different light would be cast on the ceaseless whining by the medical
profession, insurance industry and political conservatives about "too many"
medical malpractice suits.

8) Medical and support staff who withhold or misstate the actual facts of a
patient death or injury caused by medical error can (and should) be, but
rarely are, prosecuted for violating state and federal wire, mail and other
anti-fraud statutes.

9) All citizens can and should do what they can to reduce medical error
homicide rate. For example, when victims' families can identify staff who
commit, fail to report or attempt to conceal such errors, they should demand
civil and criminal justice and professional conduct investigations and
discipline.

10) And in cases of extreme recalcitrance by medical professionals and staff,
a little public shaming should not be out of the question.

NOTE 1: As used in this comment:

"Medical error homicide" refers to an erroneous, and therefore negligent
iatrogenic event that causes the patient to die. This term and its definition
reflect the fact that intent to kill is not a required element of a homicide.

"Medical Error Homicide Rate" is the number of medical error homicides
committed in a calendar year.

NOTE 2: Sources:

[http://www.huffingtonpost.com/allen-frances/why-are-
medical-...](http://www.huffingtonpost.com/allen-frances/why-are-medical-..).

[http://www.hospitalsafetyscore.org/newsroom/display/hospital...](http://www.hospitalsafetyscore.org/newsroom/display/hospital..).

~~~
hNewsLover99
CORRECTION: "Medical error homicide" refers to a medical error (i.e., an
avoidable iatrogenic event, such as mis-calculating a dosage by making a math
error, as in the famous case of the Boston Globe medical journalist, Betsy
Lehman), which is negligent as a matter of law, and which causes or
substantially contributes to the death of the patient or any other person.
This definition reflects the fact that intent to kill is not a required
element of a homicide.

------
soufron
After the food ?!?

------
musha68k
"Never touch a running system."

Complexity kills!

------
hermannj314
Wasn't a major premise of the Affordable Care Act that it was the lack of
access to medical care that was killing so many people?

Glad to know the situation is better now.

