After heart disease and cancer, the third greatest cause of death in America is medical mistakes, according to Johns Hopkins surgeon Dr. Martin Makary.
Makary, who says medical screw-ups claim the lives of at least 250,000 people a year, has urged the U.S. Centers for Disease Control and Prevention to add medical errors to its annual list of the leading causes of death. His analysis was published in The BMJ, formerly the British Medical Journal, last May ― and he probably shouldn’t hold his breath waiting for the CDC to act.
A spokesman for the CDC agrees that medical errors are important and merit attention. But the agency’s official mortality statistics for the United States are based on death certificates, which note the disease or condition for which the decedent was being treated but don’t consider the complications of medical and surgical care when reporting the underlying cause of death.
“The assumption is that prevention of the underlying condition would obviate the need for medical intervention. Second, medical errors are often simply not reported on the death certificate,” the CDC spokesman said.
Most hospitals that are safety-minded have focused on containing the spread of hospital-acquired infections and viruses, but fewer are focused on easily avoidable treatment mistakes. And even though the Institute of Medicine has long called for transparency when such errors occur, only 28 states require hospitals to report them. That’s partly because admitting and tracking errors might damage a hospital’s reputation or result in costly lawsuits.
Dr. Lawrence Schlachter, a board-certified doctor and attorney and the author of Malpractice: A Neurosurgeon Reveals How Our Health-Care System Puts Patients at Risk, described some of the most common problems patients can encounter in hospitals.
1. Something gets left in a patient in 1 of every 1,000-1,500 intra-abdominal surgeries.
Ken Kizer, former CEO of the National Quality Forum, coined the term “never event” in 2001 to refer to particularly shocking medical errors that should never occur. The list contains 29 events grouped into different categories: surgical, product or device, patient protection, care management, environmental, radiologic, and criminal. You know those stories about the surgeon operating on the wrong leg or even the wrong patient? That’s a never event.
One so-called never event that actually happens quite frequently is when foreign objects are left in a patient’s body during surgery. The most common are surgical sponges, followed by needles, scissors, retractors and clamps. A study published in the New England Journal of Medicine estimates that something gets left behind in one of every 1,000 to 1,500 intra-abdominal operations.
The results can be painful, require additional surgery and in some cases, result in the loss of life. Almost 20 percent of patients who experience a retained surgical instrument sustain a permanent injury. And 1 in 20 of those patients die as a result.
Operating room personnel are supposed to count every instrument and sponge three to four times before and after surgery. There are also surgical checklists to follow. But still, mistakes happen. Most occur in emergency surgeries, when speed is of the essence. X-rays can detect a metal object left in a patient. But sponges, well, sponges are something else.
Sponges are the culprit in more than two-thirds of all incidents. Yet the nation’s hospitals have been slow to embrace the use of sponges equipped with electronic tracking devices. In 2013, a USA Today report found that fewer than 15 percent of U.S. hospitals used sponges equipped with trackers.
Medicare now denies payment for costs stemming from such errors, and the related malpractice suits cost hospitals between $100,000 and $200,000 per case on average.
A decade ago, a landmark report on health care quality ranked lost sponges and instruments in the most serious category of medical errors. Issued by the National Quality Forum, a congressionally funded nonprofit, the report urged mandatory reporting and tracking of medical errors. But even today, not every case gets reported, notes the National Center for Biotechnology Information.
2. Some doctors are incompetent or negligent.
Doctors are not faultless, but many patients do see them as infallible. Patients routinely accept their diagnoses as being accurate, even though studies have shown that anywhere from 10 percent to 20 percent of diagnoses are delayed, missed or altogether incorrect.
“There are a thousand places where incompetence and negligence can hide in a hospital and within the medical culture,” said Schlachter. “If a seminar leader were to ask a large group of doctors how many of them know an incompetent or dangerous doctor, most hands in the room would go up.”
According to a 2016 study, 1 percent of physicians accounted for 32 percent of paid malpractice claims over the past 10 years.
And then there is the ego factor. Referring to the problem of foreign objects being left in a surgical patient’s body, Schlachter wrote in his book that many doctors care about their patients, “but they trip over their ego.” They see the accounting for surgical instruments and sponges as too mundane a task. Some surgeons don’t want to wait for an instrument count, he said.
3. Exposure to surgical smoke is like smoking 30 unfiltered cigarettes a day.
Surgical smoke is the byproduct of using high-heat electrical tools to cut and cauterize skin and other tissue. Devices that produce this kind of smoke are used in approximately 95 percent of all surgical procedures.
Surgical smoke contains roughly 150 chemicals ― many of the same chemicals as cigarette smoke ― including 16 chemicals listed as priority pollutants by the Environmental Protection Agency, as well as toxic and carcinogenic substances and even viruses and bacteria.
Exposure to surgical smoke for one day in an operating room can be equivalent to smoking up to 27-30 unfiltered cigarettes, according to the National Institutes of Health. A study found that surgical smoke could contain and transmit malignant cancer cells to benign tissue, and if that’s not enough, it also can transfer infectious diseases, including HPV.
These carcinogens, mutagens and infectious vectors pose a potential risk to the health of operating room staff as well as patients, the CDC says.
4. So many tests, so many of them unnecessary.
Unnecessary tests put patients through additional stress, expose them to unnecessary risks and account for a host of unnecessary costs.
Critics may claim that by ordering that extra test, doctors are practicing good defensive medicine, Schlachter says: “If something turns up, that extra step was the right one to take.”
Yet nearly half of primary-care physicians say their own patients get too much medical care, according to a survey published in 2011 by researchers at Dartmouth College. And the Congressional Budget Office says that up to 30 percent of the health care in the U.S. is unnecessary.
For what it’s worth, a study found that 97 percent of emergency room doctors order unnecessary imaging tests. When asked why, their responses included fear, uncertainty and other non-medical reasons.