The annual list of the most common causes of death in the United States, compiled by the Centers for Disease Control and Prevention (CDC), informs public awareness and national research priorities each year. The list is created using death certificates filled out by physicians, funeral directors, medical examiners, and coroners. However, a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death.1 As a result, causes of death not associated with an ICD code, such as human and system factors, are not captured. The science of safety has matured to describe how communication breakdowns, diagnostic errors, poor judgment, and inadequate skill can directly result in patient harm and death. We analyzed the scientific literature on medical error to identify its contribution to US deaths in relation to causes listed by the CDC.2
Poor system design results in poor reporting and thus inaccurate data. Good to know. I could make a couple of comparisons to firearms deaths, sexual assaults on campus, and of course climate change. I won’t, but you get the idea.
Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome,3 the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning),4 or a deviation from the process of care that may or may not cause harm to the patient.5 Patient harm from medical error can occur at the individual or system level. The taxonomy of errors is expanding to better categorize preventable factors and events.6 We focus on preventable lethal events to highlight the scale of potential for improvement
I don’t think that there is any malice in any of the errors. There is not even incompetence in most of them. Some of it, maybe most of it, is due to poor communications. In the hand written record days it was easy to miss something in either the writing or the reading process. Or something was written unclearly and misunderstood. With computers, a lot of that should go away, but unfortunately other errors can creep in and what I call “humanware” is the factor that can confound any system.
Before my mother died a few years back, she spent a lot of time in the hospital on multiple occasions. Her doctor (of whom I was not a fan) had given up his admitting privileges at the hospital where she went and wasn’t a very good communicator with the hospital staff. As a result, I had to spend time each time she was admitted recording her medications, medical history, and other pertinent facts and communicating them to the nurses taking care of her. Eventually, that information made it into her medical records, but it didn’t happen quickly.
I could write a separate post about patients who don’t have a family advocate with a medical advocate, but it’s not really germane to the topic at hand.
Suffice it to say that there are a lot of ways that errors can creep into records.
Here is the part where I was going to compare deaths by medical error to deaths by firearms. Only the study authors saved me that work typing that up by including this handy dandy little chart. Keep in mind that the firearms deaths are from the Centers for Disease Control (and politicalization of science0, so are probably inflated. The deaths by medical error are based on the authors literature review and calculations, so may be low or may be high. Any way you parse the numbers, deaths by medical error dwarf deaths by firearms.
Which brings me to my closing comments. Before doctors get all high horsey about the “public health crisis” caused by private citizens owning firearms, they need to figure out and solve the very real public health crisis caused by their professional colleagues.
Then we can talk about reducing deaths by guns.