Greater funding needed to reduce medical error

BALTIMORE, Md. – A recent report stating that medical error is the third leading cause of death in the United States may have raised eyebrows – and the hackles of some doubters – but the issue still remains: if this is the case, what should be done about it?

Dr. Martin Makary (pictured), a co-author of the study who is also a surgeon at Johns Hopkins University Hospital and a leading patient safety advocate, has some ideas. In particular, he said, much better documentation and reporting of fatal medical errors must be made.

As well, there should be far greater funding of research into the causes of medical errors and solutions.

Speaking on the PBS Newshour television program earlier this month, Dr. Makary said: “There are so many great homegrown ideas by doctors around the country, hospital associations, and 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 the same message back – this is not within the scope of the NIH. This is not within the scope of the National Cancer Institute.

“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 [in funding], 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.”

As a leading cause of death, with numbers much higher than for breast cancer, medical error researchers should be receiving far higher levels of funding, Dr. Makary said.

In their report, Dr. Makary and co-author Michael Daniel – both of Johns Hopkins Hospital in Baltimore – 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. – about 251,000 annually – are caused by medical error. This figure trails only the number of deaths for heart disease and cancer [of all types]. Their study was published in The BMJ.

In an interview with the Voice of America news service, Dr. Makary said no one knows exactly how many people die because of these errors – his numbers and those of other studies are estimates.

He said that it’s impossible to determine exact numbers because 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. Dr. 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,” Dr. 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.”

Dr. 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.

He noted that fear of retaliation or malpractice lawsuits that could result from accurately documenting the problem of medical mistakes is a major barrier, one that 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 healthcare 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.

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.

So what can people do right now to minimize the occurrence of medical error?

“On a bedside level, you should always go into your office visit or your hospitalization with a loved one or family member,” said Dr. Makary. “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.”