Avoiding Medical Errors

In the article Doctor Errors Kill 500,000 Americans a Year, the authors claim ½ million American are “killed” by doctor errors. The Institute of Medicine in 1999-2000 released a report that 44,000-98,000 patients a year die as a result of medical errors.

The main categories of error at the beginning of the 21st century were diagnostic errors, treatment errors, prevention errors, and system errors.

The newer article, only about 15% of a decade later, raises that number to 500,000. Is that accurate? Well, that depends on how the counting is being done, as it is an inherently complicated analysis to determine whether “a specific action or inaction directly lead to a death.”

Causality (also referred to as causation[1]) is the relation between an event (the cause) and a second event (the effect), where the second event is understood to be a consequence of the first.

A chief aspect of that complexity is the blur that naturally occurs between events that are simply associated in time, and events that are causally linked. When events are merely associated with one another, they may appear to be causally linked because one comes before, and the other occurs after, but causation is nevertheless absent. When events are actually linked by causality, however, the earlier produces or directly contributes to the later.

Sorting this out may seem achievable, but often is not. Moreover, for the purposes of healthcare analysis or litigation, it is quite easy for one side or the other to make before-after appear like before caused after. When cause and effect are obvious, then the attribution of causality is clear. Usually this only happens in simple cause-effect circumstances. Say a person weights 500 lbs, and is known to have eaten three gallons of ice cream nightly for the past 15 years. In this case the cause (eating ice cream) is certain without any doubt

But in medicine, things are rarely (or never) so simple. For example, suppose a man presents to the ED having been brought in by rescue after an MVA. He begins to have some chest pain, and an EKG is done, which shows an acute MI. Now, what was causal regarding the MI? Was it the physiological stress of the MVA, the psychological and physical stress of the rescue transport, or perhaps his wife yelling at him before he left home? Could the MI have occurred before the accident, and the physiological stress of the infarction have precipitated the accident? Or, could he have been exposed to some drug or substance that decreased his coronary flow, and been a definitive causal factor. In this example, no one knows, and claims of such knowing are highly suspect to be thoroughly biased, and likely influenced by funds on the table. There are simply a panoply of associated factors present, any one of which, or any combination of which, might have been causal. The same is true with respect to medical errors, except in this field of inquiry, causal factors within the system itself are the most dominant associated factors for which individuals in the system are frequently blamed.

Indeed those who study medical errors fully are the first to acknowledge that prevention of such errors are for the most part systemic issues. That is, humans are simply not error free; systems on the other hand, can come much closer by putting into place checks and balances to catch errors whenever possible.

In healthcare litigation, the claim made does not take into account the complexity of determining what really caused a bad outcome. The number claimed by the Institute of Medicine was considered outrageous at the time, and for good reason; indeed this number seems high and sensationalistic. They clearly equated bad outcome with caused by an error in care.

The numbers are less relevant than recognizing the presence of an underlying system problem that needs fixing. Recently, system analysis experts have working toward a plan where the individual practitioner is not the recipient of the total blame but a pathway to fixing the problems for all involved.

XpressTechnologies has developed a product, process, and multiple solutions to avoid making unnecessary errors leading to poor patient outcome. The Electronic Health Record when used properly can cut down on system wide errors but must be integrated with a complete game plan with coherent policies.