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Full Table of Contents
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Abbreviated
Table of Contents
Home Page
Patient Safety
Silence vs
Safety
Silenced
White wall
of Silence
Silencing
Conflict Of
Interest
Psychology of
Providers
Subjectivity
Blacklisting
Nurse survey
Loyalty
Mobbing and
bullying
Trust Us
Defensive
documenting
Report Rate
Risk
managemnt
SOAP
Management
Hospitals
Crime in
medicine
Sexual Abuse
Liability
Limitations
Free Speech
for Patients
Exploitation
OSMB Medical
Boards
Mammography
solutions
Medical errors
Medical Complaints
One number
Links
Injured patients who want to help and be heard,
click here.
Thomas Jefferson said that given the choice between
government without newspapers and newspapers without government, he would choose
newspapers.
In medicine we have government without newspapers. Patients
cannot find out what they need to know to make informed choices. No one in
medicine records or reports the information patients need to know the most. So
patients will have to do it.
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How Many Are Dying
Unnecessarily in Health Care?
IOM Studied 30,000 Records
from 1984
The oldest study, the 1999 Institute of Medicine report "To Err is Human," concluded that between
48,000 and 98,000 patients die each year as a result of preventable medical
errors committed in hospitals, but that was based only on data that was reported
by health care professionals who don't report most
adverse events and only on data from three states.*
HealthGrades studied 37,000,000 records
from 2000 to 2002
A more recent estimate is offered by HealthGrades, the health
care quality company. They looked at 37 million
patient records taken from three years of Medicare data in all 50 states and
D.C., approximately 45 percent of all hospital admissions (excluding obstetric
patients) in the U.S. from 2000 to 2002. They found that an average of
195,000 patients in the USA died
in each of those three years due to potentially preventable, in-hospital medical
errors. But, once again, they were working only with data that had been reported
by health care professionals, and health care professionals report few adverse events.
A study in the Annals of
Internal Medicine** examined information that previous
studies did not. They recognized the problem with basing studies only on the few
adverse events health care professionals report and looked for where they could
get unrecorded information. They conclude that 320,000
patients die unnecessarily in
medicine in the USA each year.
Their report,
written by 10 experts with various advanced degrees (including three MDs) in
the July 15, 2008 issue, sought to discover if patients' knowledge of
medical errors revealed errors that the medical records did not. In the
Annals study, serious preventable medical errors documented in medical
records of 1,000 patients hospitalized in 2003 in Massachusetts were
compared with serious preventable errors that patients themselves could
recall 6-12 months after their discharge.
Only eleven serious preventable errors were documented in
the medical records created by caregivers, but patients reported 21
additional ones that the healthcare professionals did not report. These were
confirmed by an investigating team. If the rate of documentation of
serious preventable
errors in medical
records is the same as the rate of documentation of
lethal
medical errors in the records
used by the Harvard study, a better estimate of lethal medical errors would
be 110,000 x (21 + 11)/11 = 320,000 unnecessary deaths per year. That is
approaching a thousand per day. And this estimate is based only on the cases
that could be confirmed. In an environment in which only
1.5% of adverse events get reported
by health care professionals, and an unknown number of events reported by
patients could not be confirmed, how much larger might the fatality figure
be if either health care professionals reported honestly or more patients
had the means to confirm their stories?
Death By Medicine, by Gary Null, puts the figures at
around 1 million patients dying unnecessarily per
year. He is not the only one, and his methodology is not the only methodology
arriving at that figure, but it probably is premature to quote that number at this
time.
People who work
in public health are familiar with the Accident Pyramid.*** It says, in short,
that for every fatality 300,000 unsafe acts were committed. 320,000 unnecessary
deaths suggests 90 billion unsafe acts. And patients have no means to
discover which operators and which facilities commit them the most often. They
cannot even discover where patients got murdered.
It
should be noted that there is reason to believe that health care professionals
believe in their hearts that they are doing the right thing when they don't
report these things. There is reason to believe they don't believe the evidence
of their senses, but rather believe that the evidence paints an incorrect
picture of what is true and therefore would not be understood if it were
reported. They believe in themselves so much, that they don't believe the
statistics resulting from studies. The statistics do not agree with their
personal experience, because of the way they interpret their experience and
filter it to protect themselves. That is living in a fog of
self-serving delusion. Our experience is that's what they do.
Errors?
All of these
studies examined only errors. None included the murder rate in medicine. No one
in patient safety is addressing the problems of exploitation, abuse and murder.
In our experience, health care professionals keep reciting that crime against
patients is rare enough to not be worth addressing. Patients should take stock of the fact that
in the United States of America health care is a sector where people can commit murder and the
people in charge of our well-being brush it off as not being worth addressing,
not even worth studying.
Footnotes
*The original Institute of Medicine study was based on
physician examination of the medical records of 30,000 patients receiving
care in New York hospitals in 1984. Of the 30,000 patients studied by the
Harvard group, 87 died as a result of preventable medical errors committed
while they were hospitalized. These data, when extrapolated to all
admissions in U.S. hospitals in 1997, yield 98,000 preventable deaths
nationwide in 1997 when there were 34.6 million admissions. But each year
the number of admissions increases. In 2002 there were 37.8 million hospital
admissions. For that year the estimated total is 110,000 preventable deaths
per year based on evidence in medical records alone.
But, as this site
continually points out, people in medicine do not record most of what should
be put in the record. Where else to get the information? From patients.
**From an article called "Comparing Patient-Reported
Hospital Adverse Events with Medical Record Review: Do Patients Know
Something That Hospitals Do Not?"
by Joel S. Weissman, PhD; Eric C. Schneider, MD, MSc; Saul N. Weingart, MD,
PhD; Arnold M. Epstein, MD, MA; JoAnn David-Kasdan, RN, MS; Sandra
Feibelmann, MPH; Catherine L. Annas, JD; Nancy Ridley, MS; Leslie Kirle,
MPH; and Constantine Gatsonis, PhD
in The Annals of Internal Medicine, 15 July 2008 | Volume 149 Issue 2
| Pages 100-108
The abstract is viewable at:
http://www.annals.org/cgi/content/abstract/149/2/100
*** Accident pyramid or Safety pyramid
In 1931, H.W. Heinrich theorized that for every major accident there are 29
minor accidents and 300 near misses. This theory has been reevaluated
several times, including by Conoco Phillips in 2003, where it was determined
that for every fatality there are 30 lost day injuries, 300 recordable
injuries, 3,000 near misses, and 300,000 unsafe acts.
Fatalities often are considered freak rarities and as
such are not considered events to be recorded and learned from. But the
causes of fatalities are different from the causes of injuries. Learning how
to prevent one does not lead to preventing the other. Both must be studied.
[Dan Petersen, 2nd edition, Safety Management] Unfortunately, in
medicine, neither are accurately recorded more than 2% the time. And it is
difficult to find anyone in medicine who even is aware of that.
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