
Medical error in hospitals is the third leading cause of death in the U.S. - ca98am79
http://www.kurzweilai.net/warning-your-hospital-may-kill-you-and-they-wont-report-it
======
Smudge
Thankfully I haven't had many reasons to enter a U.S. hospital, but the few
interactions I had were extremely worrisome.

For example, when my grandmother fell ill, my family spent a lot of time
visiting her. My mother, in particular, spent many days and nights there, and
her biggest complaint was the complete lack of communication between shifts.

Every few hours, someone new would come into the room, read my grandmother's
charts, wake my grandmother up, and ultimately misinterpret several important
details. Thankfully my mother was often there to correct them and fill them in
on what previous nurses/doctors had already done, but the net result was that
my grandmother barely got any rest (being constantly woken for no apparent
reason) and, had my mother not been there, a nurse or doctor could easily have
made a critical mistake when continuing her treatment.

Another example, still the same grandmother. Even though her original
condition improved (after having been rushed to a different hospital), she
ended up going home with an entirely new infection which resulted in several
more weeks of sickness and eventual recovery. The infection (C. Diff) is one
of the leading Hospital-acquired infections and is in many cases totally
preventable. It's hard to believe how many people die each year due to
infections they pick up in hospitals.

~~~
blaze33
> her biggest complaint was the complete lack of communication between shifts.

Hmm seems weird and easily addressable to me, I had to spend some time in a
hospital in Paris (France) and the staff had a meeting between every shift to
discuss how patients were going. To the point that people complained they
weren't available at that time... But yeah no experience with US hospitals so
YMMV.

~~~
hellofunk
Most human errors are easily preventable.

------
thegasman
Note the paper's definition of medical error: "Medical error has been defined
as an unintended act (either of omission or commission) or one that does not
achieve its intended outcome,3 the failure of a planned action to be completed
as intended (an error of execution), the use of a wrong plan to achieve an aim
(an error of planning),4 or a deviation from the process of care that may or
may not cause harm to the patient."

That's quite broad

~~~
darawk
Is it? Those all seem like pretty reasonable types of error. Ultimately they
have to have contributed to the death of a patient to be included. If one of
those things contributed to someone's death, I don't think i'd hesitate to
call that a 'medical error'.

~~~
gpm
> one that does not achieve its intended outcome

I struggle to see how there are any deaths inside a hospital that don't fall
into this category. E.g. a cancer patient on chemo therapy who doesn't make it
would seem to qualify.

Realistically I assume this means that they count whatever they want as
medical error, with no good rules.

~~~
surfaceTensi0n
I don't think your example would qualify unless a real error was made e.g. the
chemo killed them so there was a planning error in putting them on chemo. The
truth is that many people with cancer will not survive. In those cases, chemo
is not about saving their lives, just extending them.

~~~
aptwebapps
You're saying what it _should_ be but the parent comments are talking about
what it actually says. Specifically, "one that does not achieve its intended
outcome".

~~~
surfaceTensi0n
I'm arguing that the "intended outcome" isn't always complete recovery. If a
patient with terminal cancer dies, that doesn't necessarily mean that the
chemo didn't achieve its intended outcome.

------
tokenadult
A thoughtful point-by-point response to the underlying medical journal
publication:

"Are medical errors really the third most common cause of death in the U.S.?"

[https://www.sciencebasedmedicine.org/are-medical-errors-
real...](https://www.sciencebasedmedicine.org/are-medical-errors-really-the-
third-most-common-cause-of-death-in-the-u-s/)

Simply put, the headline of the article kindly submitted here surely
exaggerates the actual problem. What's undoubtedly a problem is that we don't
yet have good data-gathering about when patients die unavoidably and when they
die when they could have been saved by standard-of-care medical treatment.

~~~
carc
Why is this being downvoted?

~~~
extra88
Maybe because the first paragraph is a non sequitur swipe at the business of
alternative medicine and two people in particular. Or maybe because there's
apparently an online campaign against the article author.

The first paragraph may not be so random in the blog's context, I expect a
blog called Science Based Medicine would spend a lot of time doing battle with
alternative medicine adherents, but it detracts from this specific article
which does a good job deflating this medical errors headline.

------
HillaryBriss
The original study's authors suggest adding a field to death certificates
where the hospital personnel would put additional information about the cause
of death:

 _... death certificates could contain an extra field asking whether a
preventable complication stemming from the patient’s medical care contributed
to the death._

How could they do this and, at the same time, shield themselves from lawsuits
which use that "extra field" as evidence against them?

~~~
jellicle
> How could they do this and, at the same time, shield themselves from
> lawsuits

Why is that a desirable goal?

~~~
Spooky23
Hospitals are a mix of stakeholders, all of whom have different agendas.
There's something to be said for a blame-free environment where you can
actually get honest post-mortem assessments.

------
poof131
Disappointing, sad, and scary, but not unexpected. You can’t expect matters of
life and death that effect liability, public relations, and profitability to
be properly investigated and resolved by the entities directly involved. When
an airplane crashes, the airlines, manufacturers, and pilots union don’t get
to run the investigation and choose the results. Sure they are involved and
try to influence the outcome, but an external agency heads the investigation.

Medicine needs some sort of non-punitive external investigative agency. With
the scope so much larger than aviation and death often being a normal outcome,
how to structure such an agency would be challenging, but I still think it’s
the only way to really address the problem. The same applies for law
enforcement and the use of deadly force. While many of the people involved
have the best intentions, the pressures of the organization put undue bias on
any internal investigation.

It looks like an agency along these lines may have been formed [1], but the
‘At the invitation of healthcare providers’ isn’t good enough. A quick google
search found others pushing along these lines [3], and it’s interesting that
they are talking about error being the ‘third leading cause of death’ in 2014.

While critics point out that the study may have an overly broad definition of
error, it still seems that there is an issue here from anecdotal experience,
and that error shouldn’t even be in the top 10.

[1] [http://www.prnewswire.com/news-releases/pso-services-
group-l...](http://www.prnewswire.com/news-releases/pso-services-group-
launches-national-medical-safety-board---nmsb-165958516.html) [2]
[http://www.ntsb.gov/Pages/default.aspx](http://www.ntsb.gov/Pages/default.aspx)
[3] [http://safepatientproject.org/press_release/patient-
safety-a...](http://safepatientproject.org/press_release/patient-safety-
advocates-urge-the-creation-of-a-national-patient-safety-board-to-fight-
medical-errors)

------
INTPenis
I wonder how many of those deaths were in public healthcare and in private
healthcare?

Speaking as a swede I am fed up with seeing how the government undermines
public health care at every turn and promoting privatized health care. Health
care workers aren't stupid, they're mass migrating from public to private
sector. Leaving the public sector in very bad shape with no backup from the
government to keep it running.

If you like me believe that your health should not be measured by your wealth
then it's down right disgusting.

------
TrevorJ
I am ROUTINELY prescribed medication that I am not supposed to take.

I have a drug allergy, and one other simple condition that both preclude
certain medications being prescribed to me. These conditions do not change
over time, and have been in my medical history for 20+ years and yet multiple
providers have prescribed medication I can't take to me. I cross check all new
prescriptions myself as a matter of course now.

------
hellofunk
I can't say I'm surprised. I had a surgery once at a supposedly well-respected
regional hospital, and they made several careless mistakes with me. Everything
turned out fine, but there was considerable opportunity for easily preventable
things to have gone wrong if it weren't for dumb luck.

------
torbit
nothing to do with death, but how hospitals don't know what they are doing
sometimes.

when I was really young I jammed my finger. went to the hospital to get it
checked. they were putting a wrist splint on me. I asked how that helped my
finger. he quickly took it off.

If I was older I would have just tapped it up.

------
Mz
We had a discussion on this topic a week ago:
[https://news.ycombinator.com/item?id=11627213](https://news.ycombinator.com/item?id=11627213)

------
djyaz1200
The book "Black Box Thinking" by Matthew Syed has good insight on this issue,
especially the differences between how the airline and medical industries
handle errors.

------
Zigurd
In many arguments about socializing medical care, the "fact" that the US has
"the best medical care in the world" is cited as a reason to keep the status
quo. instead it appears we are paying through the nose for a system that
doesn't manage quality very well at all.

~~~
jessriedel
It's certainly debatable which countries get the best medical care for the
dollar, or which countries distribute it to people in the most fair way, or
make it most accessible to the poor. But I don't really think there's debate
that the US gives the best medical care if money is no object. My
understanding is that, with very few exceptions, the wealthy all over the
world come to the US if they have a serious medical condition.

~~~
XorNot
It is highly dubious that this is some feature of the expense of medical care
in the US. For example, it's generally recommended that for surgery, you
actually want to see a doctor who works in the public system (in Australia, my
country) because for routine procedures the guy who does them everyday, all
the time, is probably a lot better at it then the guy who can choose his
cases.

The US has a _giant_ population with first-world levels of funding from the
government - it's fairly likely that care quality is simply the intersection
of population and experience. But you pay more from the government per person,
and get less. Your system and outcomes should be _so much better_ and you all
should be angry about that. It's just at some level of size and overall
budget, you get a lot despite being inefficient.

~~~
Thriptic
> . For example, it's generally recommended that for surgery, you actually
> want to see a doctor who works in the public system (in Australia, my
> country) because for routine procedures the guy who does them everyday, all
> the time, is probably a lot better at it then the guy who can choose his
> cases.

While I agree that this is the case, the people who are willing to travel for
medical care are likely not traveling for routine cases; they are going to see
specialists for complex cases. The quality of care varies substantially across
the US, and I do think the top tier facilities in the US are some of the best
(if not the best) in the world. That says nothing about the average level of
care across the country however, and it is typically difficult to get access
to these premiere hospitals unless you know someone with connections in
medicine or have money.

~~~
Xylakant
Be careful even in non-routine cases. The specialist in question may select
his patients based on qualifiers that are in his interest. One of them is the
likelihood of recovery - high likelihood improves their track record and thus
their standing as a specialist.

~~~
Thriptic
This is fair point, but at a hospital-level in the US you do tend to see
higher mortality levels at prestigious hospitals due to the increase in
average case complexity. People are willing to take on the tougher cases.

