Notes 10

These are notes linked to from other pages on this site




“You always start with an ideology. All evil begins with a big ideology,” Philip G. Zimbardo, professor emeritus of psychology at Stanford University, said at the University of Delaware in a lecture titled “The Lucifer Effect: Understanding How Good People Turn Evil.”




Pushing the profession: how the news media turned patient safety into a priority
by M L Millenson, Visiting Scholar
Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, Illinois, USA
Correspondence to:
M L Millenson, 2735 Fort Sheridan Avenue, Highland Park, IL 60035, USA;
Accepted for publication 7 January 2002

The problem of patient safety has been repeatedly identified in the medical literature since the mid 1950s, but regular revelations about patient deaths and injuries resulting from treatment have had almost no effect on the actual practice of medicine.
Millenson ML. Demanding medical excellence: Doctors and accountability in the information age. Chicago: University of Chicago Press, 1997: 52–73.



Millenson ML. Demanding medical excellence: Doctors and accountability in the information age. Chicago: University of Chicago Press, 1997: 52–73.



Whether healthcare is regarded as a commodity or as a fundamental human right, patients deserve to be protected from abuse within it.

More effort is made to protect physicians from liability than to protect patients from abuse. And freedom from liability creates more abuse.

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JCAHO, pronounced Jayco
They say that their mission is: "To continuously improve the safety and quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations." Unfortunately the board of directors of JCAHO is dominated by representatives of the American Medical Association and the American Hospital Association, which raises concerns about conflicts of interest and the extent to which it can have a perspective that is objective and honest enough to do what must be done to improve safety and quality.

The Joint Commission evaluates and accredits nearly 15,000 healthcare organizations and programs in the United States. Operating since 1951, it is an independent, not-for-profit organization and is the nation’s predominant standards-setting and accrediting body in healthcare.

However, according to The Massachusettes Nurses Association News at,
critics say that it is more lapdog than watchdog. In that article, Karen Higgins, RN says, "The hospitals are given notice of pending surveys, and they spend months preparing to get ready. Staffing always improves around the time of a JCAHO visit, and it goes right back to normal (usually bad) immediately after."

Based on a survey of 500 hospitals inspected by JCAHO between 2000 and 2002, the report found that the organization failed to identify 167 of the 241 deficiencies state inspectors later found at the facilities, or 69 percent of the total.

During the entire tenure of JCAHO there have been regular revelations about the amount of unnecessary death and injury in medicine with no overall improvement in those numbers and almost no changes in the way medicine is practiced.

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Two Comedians
The two comedians were Jimmy Kimmel and Adam Carolla on The Man Show, a half hour comedy television show on Comedy Central. The sketch is one of their more famous ones.

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Other Humor:
According to the U.S. Dept of Health & Human Services there are 700,000 physicians in the USA and at least 120,000 unnecessary deaths caused in medicine each year. That is .171 preventable deaths per physician.

The number of people in the USA who own guns is 80,000,000. The number of accidental gun deaths each year is 1,500. That's .000188 deaths per gun owner.

Statistically doctors are 9,000 times more dangerous than gun owners.

Guns don't kill people. Doctors do.













Unnecessary patient deaths - 320,000 per year and growing
This section is updated at this link
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 extrapolated from findings based only on data that was reported by health care professionals (who don't report most patient harm problems) and only on data from three states.*

A different 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 people 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 they don't report most adverse events.

A study in the Annals of Internal Medicine** examined information that previous studies did not. They conclude that there are 320,000 preventable deaths 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 patient harm problems 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 unnecessary deaths per year.

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. They are the same people who don't record adverse events in order to protect themselves at the expense of the community of patients.

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. With that many fatalities that 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.

*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:

*** 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.