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medpundit |
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Tuesday, October 29, 2002Respondents were asked to assess their agreement with several statements from a 1999 report by the Institute of Medicine that found preventable medical errors to be the eighth leading cause of death in America. Aargh! Will this lie never die? Here’s the figures for the top ten leading causes of death in 1999 and 2000. The eighth leading cause of death was Alzheimer’s. Medical errors aren't listed as a cause of death at all. There's a category of accidents which includes accidents of all sorts - from car accidents to falling down the stairs. It's hard to believe that medical errors make up a large percentage of that particular category. In fact, it turns out that they don’t. Subsequent studies have shown that significant errors occur at a far lower rate than the Institute of Medicine would have us believe. Others have shown that the methodology of the studies on which the Institute of Medicine's position paper was founded were flawed. The Institute based their claim that doctors are the eighth leading cause of death on a study done by a team of Harvard researchers in the 1980’s that looked at adverse events in a sampling of New York state hospitals and a similar study from hospitals in Utah and Colorado. ( I can only link to the Harvard study.) The Institute took those studies one step further and extrapolated the data to apply to the entire country. There’s a fundamental problem there. It’s invalid to apply data from one year (1984 in the case of the Harvard study) to another year (1997 for the Institute’s data), and it’s invalid to apply data from one state to the entire nation. For some reason the reviewers of the Institute’s paper gave this shoddy statistical work a pass, but these guys have done an excellent job of pointing out its flaws. The other drawback to the Harvard study was their definition of error: Drug complications were the most common type of adverse event (19 percent), followed by wound infections (14 percent) and technical complications (13 percent). Nearly half the adverse events (48 percent) were associated with an operation. Adverse events during surgery were less likely to be caused by negligence (17 percent) than nonsurgical ones (37 percent). The proportion of adverse events due to negligence was highest for diagnostic mishaps (75 percent), noninvasive therapeutic mishaps ("errors of omission") (77 percent), and events occurring in the emergency room (70 percent). Errors in management were identified for 58 percent of the adverse events, among which nearly half were attributed to negligence. How do you judge an “error of omission?” It sounds suspiciously like something that would be far easier to detect in hindsight than at the time of treatment. As for the others- “drug complications, wound infections, and technical complications”, those are known risks of treatment, not errors. An error is when you write the wrong number down for a dosage or pick up the wrong medication and give it to a patient. An error isn’t a post-op wound infection or a drug side effect. The Institute of Medicine is an arm of the National Academy of Sciences. Its job it is to provide the federal government with unbiased analysis to help guide healthcare decisions. Unfortunately, the Institute has a tendency to set out with an agenda whenever it analyzes a problem, and this report was no different. Their study on racism in medicine was stacked with committee members whose life work was devoted to studying racism. The study on errors was done by people whose life work it is to monitor doctors and hospitals. It isn’t clear who was responsible for gathering the information and putting it into a report. The committee on healthcare quality whose members are listed at the beginning of the report has physicians as members, but it’s the nonmedical staff whose names appear on the title page. In the methodology section they mention the people whose input was critical to the report. They have a member from the National Patient Safety Foundation, a member from the Institute For Safe Medication Practices, and a member from the Joint Commission on the Accreditation of Health Care Organizations. They even had the creator of the system for aviation reporting. He, and one person from the VA system were the only two doctors involved in the discussions that led to the report. It’s highly doubtful that either of them are actively involved in diagnosing and treating patients. Such a collection of committee members has a natural bias toward finding errors in the system, and toward overestimating errors. Their lack of experience in practicing medicine as a group only compounds that bias. How can you expect policy wonks to understand the nuances of diagnosis and treatment, let alone to tell the difference between a complication and an error? You can’t. And that’s the fundamental problem with the Insitute of Medicine’s report on errors. It was put together by a committee of biased individuals who lacked the knowledge or the inclination to recognize flawed methodology, flawed definitions, and flawed statistics. Do medical errors happen? Of course they do. No one’s perfect, and those errors that do occur should be minimized as much as possible. But the incidence of errors has been greatly conflated and exaggerated by the Institute of Medicine’s report. It is the one and only source for the lie that the medical profession is the eighth leading cause of death in this country. They have slandered the medical profession and undermined the trust that’s the cornerstone of the doctor-patient relationship. And they did it all with taxpayer money. UPDATE: A reader emailed this information nugget: The CDC tracks something called "complications of medical and surgical care". This was the cause of 3059 deaths in the year 2000. (quite a bit less than the 49,558 deaths from Alzheimer's) I would think that medical errors are a subset of this category. Yes. And thus, an even smaller number than the IOM report claims. posted by Sydney on 10/29/2002 07:26:00 AM 0 comments 0 Comments: |
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