Medical Mistakes Kill 100,000
Americans A Year
The promise every doctor makes is ìFirst, do no
harm.î But doctors and hospitals do make mistakes. And the November 30
shocking report from the Institute of Medicine showed medical mistakes
are a common and potentially life-threatening risk. If medical mistakes
counted among the leading causes of death in America, they would be
eighth.
Surgical gaffes like amputating the wrong foot or
a deadly chemotherapy overdose make headlines. But patients may never
hear of the more subtle errors, like a delay in diagnosis or testing
that costs precious time to fight off disease. Medical mistakes costing
lives. Medical mistakes are a stunningly huge problem, says a new report
by the Institute of Medicine. It quoted studies estimating that at least
44,000 and perhaps as many as 98,000 hospitalized Americans die every
year from errors. To put that into sharper and more alarming
perspective, even the lower figure of 44,000 deaths exceeds the number
of people who die each year either on the highways, of breast cancer or
of AIDS.
It is an intolerable situation, especially when
it's taking place in the United States, which leads the world in medical
advances. The cause, according to the Institute of Medicine, is not as
much recklessness on the part of doctors, nurses and other health
providers as it is basic flaws in the way hospitals, clinics and
pharmacies operate. That kind of problem is fixable.
As a matter of fact, safeguards have already been
implemented to reduce the likelihood of such lethal medical errors. Some
hospitals are now using computerized prescriptions to ensure that
pharmacists don't misread doctors' scrawled prescriptions. At the urging
of anesthesiologists, anesthesia equipment is being standardized. And
the Food and Drug Administration is trying to reduce confusion by
ensuring that the names of new drugs don't sound too similar to drugs
already on the market.
Doctors' notoriously poor handwriting too often
leaves pharmacists squinting to decipher a dose C was it 10 milligrams
or 10 micrograms? C or even the name of the prescribed drug. Too many
drug names sound confusingly alike. Consider the painkiller Celebrex and
the anti-seizure drug Cerebyx; or Narcan, which treats morphine
overdoses, and Norcuron, which can paralyze breathing muscles.
But far more is needed: a concerted and
comprehensive effort to raise the bar on consumer safety in the health
care industry, not unlike what has already taken place in other
industries. Since many doctors already feel beleaguered by financial
constraints imposed on their care, insurers and health maintenance
organizations must also bear the burden of improving safety.
At a minimum, the Institute of Medicine wants to
reduce medical errors by half within five years. Considering the number
of people who die each year in hospitals - where they presumably go to
get better - even that goal may be too conservative.
Keeping Up with
Changes
Health care is a decade behind other high-risk
industries in improving safety, the report said. It pointed to the
transportation industry as a model: Just as engineers design cars so
they cannot start in reverse, and airlines limit pilotsí flying time to
keep them rested, so can health care be improved. Some fixes already are
under way: Some hospitals have computerized prescriptions. The Food and
Drug Administration is hunting ways to catch sound-a-like drugs.
Anesthesiologists persuaded many manufacturers to
standardize equipment and thus decreased technology-caused errors. Many
doctors now literally mark the spot of surgical incisions before
patients are put to sleep, so everyone agrees on what will be cut.
Changes Coming
from Congress
The Institute of Medicine is part of the National
Academy of Sciences, a private organization chartered by Congress to
advise the government on scientific matters. Congress just passed
legislation ordering the Agency for Health Care Policy and Research to
hunt strategies to reduce medical mistakes. The bill will even change
the name to the Agency for Healthcare Research and Quality to reflect
the emphasis. President Clinton is expected to sign the bill soon. But
the Institute of Medicine said reducing medical mistakes requires a
bigger commitment.
It recommended that Congress should establish a
federal Center for Patient Safety. It would require $35 million to start
and should eventually spend $100 million a year in safety research.
The report said the total cost of medical
mistakes, lost income and production, cost of disability and health
care, totals $17 to 29 billion a year.
And thatís not mentioning the human toll. The
government should require that hospitals, and eventually other health
organizations, report all serious mistakes to state agencies so experts
can detect patterns of problems and take action. About 20 states now
require error reporting.
But how much and what penalties they impose varies
widely. State licensing boards and medical accreditors should
periodically re-examine health practitioners for competence, stressing
safety practices. Standardized medical equipment and treatment
guidelines can help doctors keep up. Change the ìculture of secrecyî
that surrounds medical mistakes, encouraging doctors to discuss errors
as well as near misses so problems are fixed.
But is there something you can do, even from your
sickbed, to protect yourself?
Become an Expert
First, know what ails you. Ask your doctor all
about it. Research it on the Internet, for instance. Patients should
feel entitled to inquire about their care no matter how sick they are.
Second, know about your drugs. The study shows more than 7,000 die each
year because of medication errors.
Kohn L, ed, Corrigan J,
ed, Donaldson M, ed. To Err Is Human: Building a Safer Health System.
Washington, DC: National Academy Press; 1999 |
