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Comment by 13of40 | Hacker News Reader

Something like 90,000 people die every year from simple medical mistakes in US hospitals, so at some point you have to decide where to throw your money. Do you spend $200K per patient keeping dead people on ventilators just in case one occasionally comes back to life, or would that money be better spent on something else, like teaching nurses to follow sterilization checklists?

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>90,000 people die every year from simple medical mistakes in US hospitals

It doesn't really change your point, but just an FYI the studies that try to measure deaths caused by medical mistakes often can be dubious due to their definition of "mistake". For example, there are clear mistakes like mixing up patients and giving the wrong treatment to the wrong patient. But many mistakes are more questionable like if a patient is given the correct treatment but they are one of the few to experience a known but deadly side effect. The hospital is still the one to have directly caused the death, but it would be hard to argue they should have acted differently. The number of deaths can vary widely depending on how events like the latter example are categorized.

I think the definition of mistake should be "was there a different course of action that could have been taken that would have kept the person alive?"

Not all mistakes are avoidable - sometimes there is no way to know if something is a mistake until after you do it, but it is still a mistake.

If there are two courses of action both with potentially deadly side effects, your definition would consider it a mistake taking one and having the patient die due to that side effect.

I think mistake should imply doing something even though a better option was available and known (or should've been known) to the person making the decision.

Mistake: one decision, among those which were adequate to the case, was given and another one, not included in the adequate group, was followed.

Choosing one and not another, all reasonable, isn't a mistake. Having a know side effect that can't be predicted to a specific patient isn't a mistake.

Note that it is key to go further than training the nurses. You have to change the culture so that it is expected by everyone involved for a nurse to tell a doctor to stop what they are doing and wash their hands.

Don't US hospitals do that the NHS in the uk is fanatical about it

I honestly don't know what is typical. There are things like this (I went and searched it up, I have dim recall of other discussions of the culture not embracing the lists):

https://www.advisory.com/daily-briefing/2015/01/16/jama-why-...

The problem here isn't a lack of training or culture. Properly "washing your hands" takes a surprisingly large amount of time. In practice people don't do it not because they don't know how or don't want to but because they can't. They simply don't have the time either in general or sometimes in a specific situation.

If you want to make a significant impact here, you would need to hire more staff.

Leading Causes of death in the US

1) Cancer

2) Heart Disease

3) Medical Error

https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-...

Analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error in the U.S. Their figure, published May 3 in The BMJ, surpasses the U.S. Centers for Disease Control and Prevention's third leading cause of death—respiratory disease, which kills close to 150,000 people per year.

3) Is a catch-all for 'complications associated with every single form of treatment.'

Consider this case: You have cancer. You can do nothing about it, and die in 3 months, or you can have an operation, that has a 60% chance of curing you, 30% chance of doing nothing, and 10% chance of killing you.

Most people would choose to undergo the operation, knowing the risks.

Those that die will be cataloged as 'medical error'. I'd argue that cancer should get at least an equal share of the blame.

>"Consider this case: You have cancer. You can do nothing about it, and die in 3 months, or you can have an operation, that has a 60% chance of curing you, 30% chance of doing nothing, and 10% chance of killing you."

I recommend everyone ask their doctor what a p-value means before listening to any stats like this. Here is just one of many horror stories about the poor understanding of stats that pervades medicine (TBH though, this is mostly the fault of stats education):

"Nearly 40 years ago the New England Journal of Medicine published a short survey of doctors’ understanding of the results of diagnostic tests.1 The participants, all doctors or medical students at Harvard teaching hospitals, were asked, “If a test to detect a disease whose prevalence is 1/1000 has a false positive rate of 5%, what is the chance that a person found to have a positive result actually has the disease, assuming that you know nothing else about the person’s symptoms or signs?” This wasn’t a very difficult question, which made the results all the more shocking. Fewer than a fifth of participants gave the correct answer, and most thought that the hypothetical patient had a 95% chance of having the disease.

Of course, this was a long time ago, and medical curriculums now contain much more in the way of statistics and probabilistic reasoning. You might expect that if the exercise were repeated today almost everyone would give the right answer. But you’d be wrong. Earlier this year a similar study was carried out, also in hospitals in the Boston area of Massachusetts, and the results were no better.2 Most doctors who were asked exactly the same question thought that the patient had a 95% chance of having the disease." http://www.bmj.com/content/349/bmj.g5619

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