"If we treated medical error as a disease, it would be the third-largest killer in the United States," said Dr. Marty Makary, lead author of a study on fatal medical errors in the U.S.
Heart disease and cancer tie for the top two causes of death.
In their study, Makary and co-author Michael Daniel — both of Johns Hopkins Hospital in Baltimore, Maryland — looked at four large studies, including one that analyzed medical death rate data from 2000 to 2008. Based on that, they calculated that 9.5 percent of all deaths each year in the U.S. are caused by medical error. The study that was published in The BMJ.
Makary says no one knows how many people actually die because of these errors. U.S. death certificates don't have a place to list medical error under the cause of death.
Instead, the U.S. Centers for Disease Control and Prevention, or CDC, and health agencies in other countries use billing codes — codes insurance companies use for payment of medical care — to determine the causes of death. Makary says medical error is the only area of medicine that is not documented.
"As a cancer surgeon, we go through this incredible process to measure our national cancer statistics, patient by patient,” Makary said. “I see a patient with cancer, and I have to document the age and stage of the patient and the subtype of the cancer. And that goes into our National Registry, and each year with millions of dollars of investment we put out our national cancer statistics, all the types and subtypes broken down in this complex report. We should do the same for medical error."
Push for openness
Makary added that unless mistakes are included in the CDC's registry, no one will know how to reduce the number of deaths from medical mistakes.
"We can't really get to the bottom of the problem unless we can create a culture where there's an open and honest discussion of the problem," Makary said.
Fear of retaliation or malpractice lawsuits that could result from accurately documenting the problem of medical mistakes is a major barrier that Makary says needs to be overcome.
"We need to interpolate the best available science, so our national health statistics are accurate. Right now they're not accurate," he said.
Makary says mistakes will always be a possibility because doctors, nurses and others involved in health care are human. He said these mistakes don't mean the health practitioners are bad, but, he says, with accurate information, systems and protocols can be made safer. Right now, he said, there's only anecdotal evidence.
For example, "the most common dangerous procedure in an emergency room today, according to many emergency room doctors, is a patient handoff," Makary said. That's when the staff changes shifts, or patients are sent for a procedure and their information is not passed on.
The researchers are calling for a change in the way deaths are classified on death certificates, so that health workers can find the weak spots in patient care and work to reduce them.