Is fatal medical error a leading cause of death?

The CDC does not list “medical error” as a cause of death in its annual mortality statistics. But according to researchers from Johns Hopkins University, medical errors are the third leading cause of death in the nation. Hari Sreenivasan talks to Dr. Martin Makary of Johns Hopkins, the report’s author, about why medical errors are usually ignored and how patients and doctors can try to avoid them.

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    For the better part of two decades, there's been a growing recognition that medical errors kill too many patients in the U.S.

    While exact numbers are elusive, a new analysis and estimate portrays an even grimmer picture. The new paper finds that as many as 250,000 people die each year from errors in hospitals and other health care facilities. That would make it the third leading cause of death in the U.S., ahead of respiratory disease, accidents and even stroke.

    Dr. Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, joins me now.

    So, how did we get to this number? What did your research find?

    DR. MARTIN MAKARY, Johns Hopkins University School of Medicine: Well, we took the best available studies, the data from the medical literature, and we basically came up with a meta-analysis point estimate, and then asked, where would that fall if medical error were counted as a disease?

    It turns out that we learned that the CDC doesn't consider medical error to be a cause of death in listing our national health statistics each year, even though the point estimate comes right in between number two and number three on the list, which means medical error is the number three cause of death in the United States. We're just not measuring it.


    OK. So, let's talk a little bit about the methodology.

    If the numbers are scarce, are these studies representative enough sample sets to be able to extrapolate this quarter-million?


    These are studies of hundreds of thousands of hospitalizations in the top medical journals. And they are updating the 1999 Institute of Medicine report.

    And there's broad consensus that the range is somewhere between 200,000 and 400,000. Our analysis came up with 251,000. No matter what number you pick, it is well above the currently listed number three cause of death. And it turns out that the reason it's not being counted is that the system relies on billing codes to compile our national health statistics.

    But people don't always die of a billing code. They can die from diagnostic errors, fragmented care, preventable complications. These are not things that are captured in national health statistics. That list of most common causes of death in the United States, that list is a big deal.

    It informs all of our research funding priorities as a country, all of our public health campaigns. We spend a lot of time and money on heart disease and cancer, but we haven't even really recognized that the third leading burden on health in America in terms of death is medical error in its many forms.


    So, how do systems change to try to adapt for this? I remember there was a book written a while ago about the checklist, and actually preventing surgical errors just by something as simple as that.

    Are there systemic improvements that we can make to try to decrease this error rate?


    Well, there are so many great homegrown ideas by doctors around the country, hospital associations, national collaboratives.

    But the important work that they're doing is vastly underfunded and underappreciated. Our large research center in patient safety at Johns Hopkins has applied for numerous federal grants, and we keep getting message back, this is not within the scope of the NIH. This is not within the scope of the National Cancer Institute.

    And all of these grants are relegated to a very small agency with a fraction of the budget, $300 million for the entire agency, including the grants. If you look at the number of people that die from breast cancer, it's about a fourth or a fifth of the number of people that die from medical care gone wrong.

    And yet they have billions more because of the great lobbying efforts and the vocal advocacy work of that group. Well, it turns out that it's not proportional to the burden of preventable health in America.


    How do you capture the number of people who might not be killed by a medical error, but might be with some serious negative health outcomes when they leave the hospital?


    Well, studies in — even in "The New England Journal of Medicine" show that as many as one in four patients in the hospital will have some medical error that they experience, almost always nonconsequential.

    And it's estimated that about half of 1 percent to a little more than 1 percent of these errors could actually be fatal. If you extrapolate the numbers to all U.S. hospitalization, that's where this 250,000 estimate comes from. That's not even counting people that die at home or sometimes through limited insurance networks or cracks in the system that result in deaths.

    It doesn't include outpatient office deaths or ambulatory surgery deaths. So, we think that the estimate is a solid estimate. There's broad consensus in the field. It's in that range. And it doesn't even include a lot of other types of medical errors that lead to death.


    All right, so I'm a patient. How do I figure out the hospital I might be taken to or that I'm already in is kind of the lowest that it can be on these error rates? Or what do I do to inform myself? What kind of questions do I ask a doctor or a hospital about my care?


    Well, on a national level, this is exactly why we need to measure the problem.

    On a bedside level, you should always go into your office visit or your hospitalization with a loved one or family member. They're an important safety net. And, certainly, patients that we see that come in with that support system are often critical in coordinating care.

    Also, ask about a second opinion. If you're going to have something major, like an operation or start a medication, sometimes, it's worth getting a second opinion, because about 20 percent of second opinions are different than the first opinion. So, it's good to know all the treatment options, be well-read, and come in with a loved one.


    All right, Dr. Martin Makary of Johns Hopkins, thanks so much.


    Great to be with you.

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