Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)
hopkinsmedicine.org
hopkinsmedicine.org
That's because they're hard to standardize. What qualifies as a medical error? It's easy to go back after the fact and analyze a case where someone has a poor outcome and say 'we should have done this another way'. That doesn't mean there was any indication at the time that the other way would have been better or that the poor outcome could have been foreseen.
I do believe there are a lot of medical mistakes made. I'm a little skeptical that there are legitimately 250k that result in unnecessary death each year. I assume many of those 250k were being treated for serious illnesses that may have taken their lives anyways (not all medical interventions are 100% effective). It would be nice to have a standardized definition, but I'm not sure how that's possible unless we are only talking about treatment received was different than treatment ordered.
summarized by the meme
it takes two wipes to know you need three, but three to know you needed two
If we just classified things that are obvious. Wrong medication applied (ie paper says to deliver 10mg of Advil but you got a vitamin C tablet), wrong leg amputated, wrong patient data looked at leading to a bad diagnosis. We would likely find a large number of incidents, however no way on earth will you get the American medical cartel to report on them honestly.
From limiting residency slots, making it nearly impossible to hire foreign doctors and lobbying for safe medications that are sold over the counter in the rest of the world to be sold as prescription only in the US. Just to name a few, the AMA has served it's members well to the detriment of anyone buying healthcare in the United States. That to me is a cartel, they just use a "certificate of need" to enforce it's will rather than a gun.
https://www.ama-assn.org/education/accelerating-change-medic...
They were actively lobbying to reduce residency slots as late as 2012. They only started the program you linked to when became common knowledge that they were attempting to limit the number of doctors.
Rather than copy / paste a comment: https://news.ycombinator.com/item?id=30108269
Edit: Funny enough I was replying to you back then too. Small world.
From purely anecdotal experience, that number is totally believable. Again anecdotally, the medical field seems to only have two kinds of people, the extraordinarily competent and dedicated, and people who don't give a whiff of a shit. The medical bell curve looks more like a bathtub.
There's data flowing all over the place. But perhaps the lawyers and the insurance stand in the way of improvement?
The human body is complex. Why not look for as much help as possible?
That's not a good enough reason.
Given the social and financial magnitude the excuse is nearly criminal.
But.
If they can identify the importance of hand sanitation and implement programs to ensure that, then there is hope. But as it is, it feels like the land of "that's how we've always done things."
Note: this isn't only hospitals but extended care facilities. They're printing money on the backs of the suffering and losses of others.
Do no harm?? Perhaps it once meant something. No much anymore.
We can do somewhat better at measuring quality for larger provider organizations across patient populations. The NCQA HEDIS measures are evidence based and reflect current consensus on best practices.
Suggesting what is available be tracked isn't ignorance, it's innovation and improvement 101. It's a call to prevent waste and unlock societal value. To suggest otherwise is lazy and insanity.
Or perhaps the industry is afraid of something? Fear makes for great excuses.
GP: This condition X is much worse than normal, so I'm going to refer you to Dr. A, the best I know in the field.
Aggregate enough of this and Dr. A has worse outcomes on paper for condition X than everybody else, since s/he gets the patients with the hardest to treat coming in.
That's why I said you're what people say you are. Heck, I don't know my own statistics and I don't know where I stand in comparison to my colleagues. Yet I enjoy a very good reputation with colleagues, but patients often are weary of me because I'm socially awkward.
Weary means tired.
Physicians sometimes jokingly refer to surgeons as "technicians" because what they are doing is often more discretely defined, clearer boundary conditions, clearer indicators of performance/success/quality (especially over X number of cases when you know the national averages for outcomes), and ultimately of a mechanical nature. The work physicians do can sometimes be described similarly, but much less frequently and it can be much harder to do.
The physician/surgeon distinction is a critical one in medicine that is under-appreciated in most conversations about "doctors".
I'll let you make some quick inferences using this video https://www.nejm.org/do/10.1056/NEJMdo004274/full/?requestTy... from this paper https://www.nejm.org/doi/full/10.1056/NEJMsa1300625
Crucially, if you can get someone to hide which surgeon is skillful and which one is not and view the video and judge for yourself, you might be surprised at your skill in differentiation. In my experience, my friends have 100% guessed which surgeon is better correctly. So it is possible that this is Sorites-style.
I know a surgeon with a substantial rate of spectacular failure and a very bad reputation. But most of the time, outcomes are excellent. Is that a bad surgeon on average? No idea. And Im in the OR every day.
I assume the general silent belief would be that your guy with the spectacular failure is some kind of "take the tough cases" dude?
By the way, when I was much younger (maybe 10-15 years ago), I recall my dad coming back from an AO Foundation conference where there was a talk about some particular procedure in some Scandinavian country where the range of outcome quality was so high for a particular non-emergency THR/TKR or something like that and so they shut down the procedure in the remote hospitals and centralized it in a few (3?) tertiary healthcare centres. Do you recall something like that? I have this memory in my head but I can't find the original material. The story is so good: EBM driving patient outcomes; but I can't find it so I don't share it and I would like very much to, if it is true.
No, the silent belief is that he's the worst surgeon we have.
> they shut down the procedure in the remote hospitals and centralized it in a few (3?) tertiary healthcare centres. Do you recall something like that?
That's become an extremely common strategy for specialized surgery throughout Europe.
Haha, classic! I love it! I was honestly a little worried of offending you if he was a friend.
> That's become an extremely common strategy for specialized surgery throughout Europe.
There we go. Fine, I'll just go look it up.
It is important to understand that in the American private healthcare system, the doctor is the true “customer” of the hospital, in that, with the exception of services provided by hospital-employed physicians, the things the hospital itself can actually bill for have to be ordered by physicians in private practice who have patients admitted to the hospital.
There is a tremendous power imbalance between physicians and non-physician clinicians and a powerful incentive to cover up bad acts by bad doctors who perform a large number of profitable procedures.
That's the problem with a fragmented health system. A lot of doctors are specialists in a certain procedure and want to repeat their pet procedure on every patient they see. I saw this with my ex who had chronic leg pain. Most of the doctors we met just wanted to repeat what they do every day (and makes them good money). There are only a few doctors who have a wide knowledge of the area and can recommend a treatment that actually fits.
The only missing peace is the a doctor on the care team who chooses which type of surgery is best, becasue once one is referred to a specialist: they are going to get that specific specialized care.
Perhaps such a system incorporates some aspects of private enterprise, but ultimately it should still be seen as a non-private system.
A truly private healthcare system would allow anybody to practice any kind of medicine at any time, without specific requirements and restrictions being imposed by the state.
It would be up to each patient to decide whether or not he or she will deal with a particular practitioner or provider of services. (Of course, this can be complicated in the case of an incapacitated patient, without prior planning.)
As is typical with non-private/socialist/communist systems of any sort, where natural free market balancing forces such as consumer choice, competition, and reputation are limited or absent, we should expect to see the inefficiencies you described, including significant quality variation, bureaucratic games, and misaligned incentives.
Healthcare in America seems very non-private in nature to me. It may not be as overtly non-private as the healthcare systems in Canada or many European nations, but it certainly does not seem to be private, either.
Even today, organized healthcare beyond vaccines and antibiotics has only a marginal impact on lifespan and healthspan. It's way behind sanitation (clean drinking water, sewage systems, waste disposal) and lifestyle issues (substance abuse, obesity, lack of exercise).
I think the no wiff of shit group can be split in two. Those who never gave a shit, and those who have been beaten down by a system that has normalized profits over patients.
Yes, the treatment runs the gamut, but the overall healthcare system - sans the higher end (naturally) - is more checklist-driver assembly line than patient care. It's not about quality, the system runs on quantity.
Of course things are missed, they were never looked for in the first place. Fwiw, I saw this happen to my father first hand. I dred the day my mother or I have to depend on the healthcare system. It's not all bad. But the odds favor the house.
That said, there are improvements that can be made. We have very low health literacy in the US and too many providers assume the patients are as literate as them. We need a much stronger teach back style encounter. As above, we need most care done by mid levels. We need to realign incentives among the patients, providers and payers. This is quite broken outside of derm and ortho.
That doesn't mean that they make mistakes, some extremely competent workers just do what they're told. But I don't know of any evidence that hospitals have gone through the same engineered hardening process as heavy industry (eg, airlines) so I expect huge gaps between actual practice and what is possible. I've never seen a hospital process that looks to have been given an engineered finish & I don't think they have enough mathematicians floating around to squeeze for efficiencies.
My wife for many years has been complaining of bone and joint pain, strange rashes, and other odd symptoms suggestive of an auto-immune condition. I kept telling her to ask her doctor for at minimum an ANA to see if it comes back with anything. Her doctor kept brushing it off as "stress and anxiety" - something I've learned incompetent medical professionals throw around without ever gathering a mental history or referring the patient to a psychologist - and basically refused to do further tests. The GP basically wrote her off as a hypochondriac with zero evidence; no tests, no referrals to a mental health provider, no looking back at her history, nothing. Doesn't "give a whiff of a shit" is spot on.
I finally convinced my wife to see another GP. This one definitely fits the bill of "extraordinarily competent and dedicated" and on that first visit the new GP ordered an auto-immune panel. Well well well, she came back with high ANA and Rheumatoid Factor markers. She's been seeing a rheumatologist since then who has been evaluating her for rheumatoid arthritis and lupus.
EDIT: this is not my only anecdotal experience either. There's so many of them. For myself: over many years I was slowly losing sensation from the neck down along with a myriad of other neurological issues that were strange but had no specific point of origin. Got several MRIs all of which came back inconclusive.
About 3-4 years later the problem suddenly progressed to me running into walls, losing significant sense of sensation, and losing my balance. I visited an orthopedic clinic and got a second set of MRIs (brain and neck), but this time I asked for a CD so I could review the material myself. The radiologist reported no issues, but I used radiopedia and medical journals to study and cross-reference normal/abnormal MRIs with mine. I found an area between C5-C7 on my neck with significant spinal cord compression. The orthopedic doc read off my radiology report and said "your results were normal". I ended up begging her to go through the MRI stack with me just to see it with her own eyes. She reluctantly agreed. We get to the C5-C7 section and she pauses, says "I'll be right back, I need to consult with one of our surgeons" and boom, I was scheduled for surgery for the next month. Unfortunately I didn't make it a month. Over the next week things deteriorated quickly and I ended up having emergency surgery.
The former will however cover for the latter. Same thing with police unions. That's why it's so hard to prove malpractice.
Now that I've had a little more experience with doctors and hospitals, I'd say they were spot-on.
It's also completely inefficient. Humans make judgement calls based on available resources. If everyone over 45 received "optimal" care, they would all effectively live in hospitals.
there's a 4X difference between good surgeons and bad surgeons in terms of bad outcomes or complications. And the same study shows that surgeons are actually accurate in terms of assessing who is good and bad but there's really no way for patients to find out before surgery
By way of example, let's take a look at WHO data[0]. Across Europe, the leading cause of death for children under 4 is congenital anomalies. That sounds bad in isolation, but is actually pretty good in context. First, because the actual rate at which children die from congenital anomalies in Europe is a fair bit lower than the world-wide average, but most importantly because those anomalies float to the top simply by virtue of every other cause of death being exceedingly rare.
0. https://www.who.int/data/gho/data/indicators/indicator-detai...
Don't aircraft have more or less standardized controls and displays?
Commercial pilots (and military) are required to train and qualify on a particular aircraft before being allowed to fly it. Controls can differ, but it's generally the difference in flight characteristics/handling that is the difference. Although we can see that the different computer related controls and lack of training were a factor in the Max crashes.
To be clear: with the computer entirely powered off, the plane would have flown just fine. Not exactly like other 737s, but more like them than anything else.
Sounds to me like the computer was in fact in control of the plane if it causes it to crash. The "computer" is the MCAS system that sits between the pilot and the actual control surfaces. This is a fly by wire aircraft.
Yes they could have turned the MCAS off and had it fly ok... if they even knew it existed. Although they weren't trained on the different flight characteristics they would experience with it off either.
"with the computer entirely powered off, the plane would have flown just fine."
Just to be clear, if you had a total computer failure or power down, a fly by wire aircraft could not function. I assume you are only talking about the MCAS.
But, the computer can yank on those cables, and it can also run the elevator trim up and down, and does. So, no, I am not just talking about "the MCAS". There is no such thing. That is a software feature that is part of the autopilot system, not any sort of hardware. They could have pulled the circuit breaker on the whole flight computer, and flown without it.
I feel this framing mis-allocates blame away from Boeing and towards airlines. The MAX was specifically designed to not require a new type rating (they have now introduced one). And no amount of training is a reasonable substitute for the autopilot with a habit of nosediving into the ground because you were too cheap to build fault-checking into your AOA sensor subsystem (an oversight that should have made the MAX fail certification).
If they would know that the system even existed then maybe they would have known how to disengage it.
Yes, the design was flawed. Even then, you train for equipment failures because everything can break. It's hard to do that if your not even told that the MCAS exists.
The training aspect still squarely places blame on Boeing and the FAA for crearing/approving a design that didn't mandate additional training.
My expectations might be too high, but yes I expect their training to include something along those lines. Perhaps not "computer is trying to kill you" specifically, but "computer is off or malfunctioning". And I would expect the airplane to have a secondary/backup computer at minimum, these systems are supposed to be heavily redundant after all).
Sometimes it’s still worth it. The aviation industry has had to deal with this forever because its hard to hide a plane crash. But in the end we have a very reliable mode of transportation despite its inherent risks.
Accidentally overdosing an elderly or critical patient? Hell the nurse that did it might not even know.
I’m sure there are ways to classify products to help with this. Anything where operator error creates a life safety issue, like IV pumps, could have some pretty rigorous controls over UX modifications.
There isn't a single definite answer, it depends on how expensive the regs are and how much they help avoid damage.
Are they the same group of people each time?
They are coming at least from different continents, but obviously to answer the sibling's comment they are selected by the company, from a pool of advanced users or early adopters, so not necessarily a good reflection of the whole population of final users.
And this is an issue in itself because the product is influenced by expert users, but at least, you cannot release a totally horrible or misleading UI that no user has ever seen before.
The other side effect, intended or not, is that you cannot change the UI at every iteration of the product because these tests tends to be costly, as a result, the evolution of the design is quite conservative, which might also explain in part why medical devices UI tends to look "outdated".
I also work for a device company and a lot of these panel members aren't really competent at giving good feedback because they lack the technical knowledge. And the FDA mostly just checks for completeness of paperwork. They look at the actual product only once there is a problem in the field.
No, not really. There are similarities in avionics, bare minimum instrumentation and historical conventions but there are type ratings for commercial pilots - they train on each one specifically. Some aircraft are similar enough that they have “common type ratings”. But an Airbus and a Boeing look very different.
Airbus A320 cockpit: https://airbus-h.assetsadobe2.com/is/image/content/dam/produ...
They aren't very different. For normal flying, the biggest difference is that Boeings have yokes and Airbus uses sidesticks. The important stuff is all roughly the same.
Though you ignore the relevant point made about the autopilots. The entire workflow of the flight computers differs. And ask any pilot type certified in both, they typically have preferences.
I’m not arguing these need to be made more standard but there’s a continuum where at one extreme the standardization is so rigid that muscle memory transfers from type to type. That’s not the case here at all.
https://gidmk.medium.com/medical-error-is-not-the-third-lead...
Unfortunately a lot of people on HN will just read the headline and think this is true, when it's very far from being the case. I wish we could link this whole thread to the refutation instead of further propagating this misinformation.
Probably is.
If I had to tell you about all the medical mistakes experienced by just my immediate family, just the facts, I would be at it all day long.
Bugs are a fact of life in development, nobody thinks software having any bugs at all is normal or that bugs are an irrefutable indicator of incompetence. That’s because anyone with any knowledge of Tyne subject has developed software and spent a huge part of that time fixing their own bugs.
The way you deal with that is through testing, defensive coding, making software maintainable, etc. You minimise the impact bugs have and try to ensure mistakes are recoverable. You also avoid counterproductive measures like punishing bug reporting, because that will just lead to cover ups and sweeping the problems under the rug.
The last thing we want to do is punish the reporting of medical errors. So yes I absolutely agree, and the way to do that is to build an honest and healthy culture around reporting of medical mistakes.
Medicine depends overwhelmingly more on manually applied procedures that would be automated, in a computer, as patients and staff manifestly are not. So, the same mistakes are repeated again and again. A software fix would correspond to changing a checklist.
Still, it would be no bad thing to use checklists for manual processes in software development, but I have never heard of any.
From the article:
The problem is that this is very subjective and mostly assessable in hindsight — it’s easy to say on reviewing a person’s chart that they might’ve done better on different medication, but whether that really does constitute a medical error is complex and not nearly as cut-and-dried as the BMJ paper suggests.
These are not the same thing
Are you part of the medical field yourself? If so then I wouldn't trust anything you say given that if the statistics were true, what you're saying has a high chance of just covering yourself up.
I expect the data can't be completely trusted in either direction.
The incentive for retaliation is simply customer unhappiness. Patients don't just sue doctors because doctors are sitting on a pile of money, people don't behave this way. Most People sue because they are pissed.
However if you caused someones death and don't want to go to jail... well that can be swept under the rug, people actually do behave this way.
Dead men dont leave reviews
And these days, medical research is excellent--if only by volume. I know people here like their canned responses--"small n!", "in mice!", "correlation != causation"--but when you're trying to make a diagnosis, every little clue helps!
I can't honestly attribute excellence to the typical medical practitioner.
> The researchers caution that most of medical errors aren’t due to inherently bad doctors, and that reporting these errors shouldn’t be addressed by punishment or legal action. Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability.
I respectfully disagree. All these are systemic problems as indicated and need to be solved by a revamp of the whole system. They are not magically going to fix themselves, there is no financial incentive to do so.
That a death qualifies as a medical mistake means that proper treatment existed. For example let's say that 50% of people die from "the plague". The plague is lethal and untreatable, no medical mistakes can be made because nothing can be done. One day, a cure is found, cheap and 100% effective, unfortunately, the procedure is tricky and as a result, 1 out of 5 times, it is done improperly and the patient dies.
In the end, 4/5 cases survive, which is great news, is used to be zero, but if we look at the share of deaths because of medical mistakes, it has increased a lot.
Of course, it needs to be fixed, but usually, it is something we know is fixable, better than a disease without treatment.
I believe this isn’t compared to no intervention. It is compared to a perfect intervention.
This kind of claim pollutes reasonable discussion.
To say something informative, give the percentage.
- the figures come from studies with methodological issues (non-representative populations, overly-broad criteria for what's counted as a death from medical error)
Afaik he does mostly videos and dont do blogs. Anyways one argument presented in the video (but dont know if its relevant to this post) is that the datasets used sometimes dont differentiate between medical error and medical harm. Medical harm is where you need to do a particular intervention, but the possible side effects of the intervention leads to the patients death. Furthermore the line between medical harm and medical error is fuzzy especially when you dont have all the information at hand when doing the procedure. The datasets for the papers mentioned in the video were retrospective
For proportion, according to the CDC[1] there were an estimated 100,300 drug overdose deaths in the United States during 12-month period ending in April 2021
Although this report is from 2016, which was before COVID and mandatory masking. WebMD says that in the interim, deaths from respiratory diseases have also soared, but I couldn't find any numbers.
[1]: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/...
Mark Cuban's project of selling off-brand medication for cheap is great - insurance companies don't want to work with them, but if said insurance companies still require their customers to pay for medication and that project is even cheaper than that, they'll get competed out of the market.
Also that free market thing is a lie, it's in the medical industry's interest to keep prices high and to not have competition / undercutting happen.
I'm not familiar with the peculiarities of the US healthcare system, but why wouldn't insurance companies work with off-brand medications? If it costs less it's good for them, no?
What's better?
(Why can’t it be both?)
If the 60% profit margin is illegally high, then no, it's worse. They'd be better off paying more money for the same thing.
There is a tax incentive at work here as well. Individuals enrolled in high-deductible health plans (HDHP) can often receive a federal income tax break, so you have to factor that in when calculating your net cost.
Deductibles are generally going higher because healthcare providers and pharmaceutical companies raise prices every year, and because we have an increasingly unhealthy population that demands more services. Insurers try to hold down those increases but with limited success, so they pass those costs on to their customers (employers), and those customers in turn pass on the higher costs to their employees.
It's great and going to help a lot of people. But it's still not cheap compared to a lot of other countries which either provide free medication or medication for a fixed fee per item (usually around $10-20, varies by country).
E.g. Medicare has a substantially higher demand for drugs than most single payer universal healthcare systems due to a combination of number of people covered plus covering mostly older, more expensive, patients. It's larger than the UK's NHS for example. But Medicare is subject to various legal restrictions on their ability to negotiate the best prices possible, while the NHS can use whatever leverage it pleases.
I am also curious to understand if European, UK and Asian healthcare systems suffer from substandard care problem.
To be precise: sugar without enough fiber causes illness. With enough fiber, as is provided by all fruit except grapes, sugar absorption is delayed long enough that intestinal bacteria get to eat most of it. Keep your intestinal bacteria fed; if not, they eat you.
As an ex-doctor, I can tell you that I very quickly realised that at the top of my "surgical sieve" (a mnemonic that helps docs consider categories of differential diagnoses) one should always start with the category "Iatrogenic" before considering other, more textbook-medicine differentials.
And also that for some reason, most doctors seem to treat this category as last on the list, if they think of it at all.
(I also met a few folks who took what they needed to do well on the MCAT then also did some practical courses on information science or focused on art so they could have something to do that would let them turn off their brain after work other than binge reality tv, and most of them are doing OK.)
Further, while at many universities there is a defined "pre-med" major, there is no such major at the University of Pittsburgh, where I obtained my BS.
So if someone who is a Pitt student says "I'm pre med", they're engaging in a best, a bit of stretching of the truth in order to impress people.
When myself, more of a science oriented person, would say "There is no premed at Pitt. What do you study? Biology? Chemisty? Something else?" they would get angry and refuse to interact.
This is known as "narcicistic injury":
>Narcissistic injury and narcissistic scar are terms used by Sigmund Freud in the 1920s. Narcissistic wound and narcissistic blow are other, almost interchangeable, terms.[76] When wounded in the ego, either by a real or a perceived criticism, a narcissistic person's displays of anger can be disproportionate to the nature of the criticism suffered;[12] but typically, the actions and responses of the NPD person are deliberate and calculated.[2] Despite occasional flare-ups of personal insecurity, the inflated self-concept of the NPD person is primarily stable.[2]
https://en.wikipedia.org/wiki/Narcissistic_personality_disor...