According to the American Academy of Pain Medicine (AAPM) pain affects more Americans than diabetes, heart disease and cancer combined. Why are so many people in pain? We had planned to answer this question in today’s blog but as we began to do the research another story emerged.
Most people are aware that the two big “killers” in the US are heart disease and cancer. And, it is true, both of these diseases cause a lot of suffering for many. But, most people aren’t aware of what is likely the 3rd leading cause of death.
Would you believe it’s not strokes, auto accidents or even diabetes?
Looking at the most recent 2011 CDC report you see the numbers looking like this:
- Heart disease: 596,577
- Cancer: 576,691
- Chronic lower respiratory diseases: 142,943
- Stroke (cerebrovascular diseases): 128,932
- Accidents (unintentional injuries): 126,438
- Alzheimer’s disease: 84,974
- Diabetes: 73,831
- Influenza and Pneumonia: 53,826
- Nephritis, nephrotic syndrome, and nephrosis (kidney disease): 45,591
- Intentional self-harm (suicide): 39,518
Wait! You don’t have the answer yet: as Paul Harvey used to say, ”Now the rest of the story…”
Let’s begin with what appears to be the fifth leading cause of death in America according to the CDC: Accidents (unintentional injuries), which claimed 126,438 lives in 2011.
This category—Accidents: Unintentional Injuries has been broken down into 3 categories:
1. Unintentional “fall” deaths – 27,483
2. Motor vehicle traffic deaths – 33,783
3. Unintentional poisoning deaths – 36,280
When it comes to “untimely” deaths in this category, there may be more than the titles suggest to these three categories. The word “fall” can mean anything from a physical movement to a malfunctioning medical device. When it comes to “unintentional poisoning” this may mean a mistaken medication, dosage or even placement of the medication. Other “poisons” include prescribing too many pain medications and not informing the people of their potential harms. When you think of the famous stars that have died from “accidental overdose” in the last several years coupled with the CDC report that came out last week proving that since 1999 more doctors are prescribing pain medications especially to those between 55-65. It is that age group that shows the greatest increase in death due to prescription painkillers.
It seems that every time researchers estimate how often a medical mistake contributes to a hospital patient’s death, the numbers come out worse.
In 1999, the Institute of Medicine published the famous “To Err Is Human” report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted pervasively in the media.
The Office of Inspector General for the Department of Health and Human Services said in 2010 that poor hospital care contributed to the deaths of 180,000 Medicare patients alone in a given year.
A 2013 study published in the issue of the Journal of Patient Safety have the numbers much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death.
That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second.
Top Ten List of Medical “Accidents” that Can Kill You in the Hospital:
#1. Misdiagnosis. The most common type of medical error is error in diagnosis. A wrong diagnosis can result in treatment delays, sometimes with deadly consequences. Sometimes more effort has been placed into creating a list of what you don’t have rather than pointing to what is really wrong inside of you.
#2. Unnecessary treatment. Nearly every week there is a news story of some doctor or hospital that has been found guilty of prescribing unnecessary treatment that costs people their lives.
#3. Unnecessary tests and deadly procedures. Studies show that $700 billion is spent every year on unnecessary tests and treatments. Not only is this costly, it can also be deadly. CT scans increase your lifetime risk of cancer, and dyes from CTs and MRIs can cause kidney failure. Even a simple blood draw can result in infection. This is not to say that you should never have a test done; only to be aware that there are risks involved, and to always ask why a test or procedure is needed.
#4. Medication mistakes. A grave concern is the number of wrong medications given to patients; a 2006 Institute of Medicine report estimated that medication errors injure 1.5 million Americans every year at a cost of $3.5 billion.
#5. “Never events”. Virtually everyone has heard the story of operating on wrong limb or the wrong patient. There are more horror stories. Food meant to go into stomach tubes go into chest tubes, resulting in severe infections. Air bubbles go into IV catheters, resulting in strokes. Sponges, wipes, and even scissors are left in people’s bodies after surgery. These are all “never events”, meaning that they should never happen, but they do, often with deadly consequences.
#6. Uncoordinated care. In our changing healthcare system, the idea of having “your” doctor is becoming a relic of the past. If you’re going to the hospital, chances are that you won’t be taken care of by your regular doctor, but by the doctor on call. You’ll probably see several specialists, who scribble notes in charts but rarely coordinate with each other. You may end up with two of the same tests, or medications that interfere with each other. There could be lack of coordination between your doctor and your nurse, which can also result in confusion and medical error.
#7. Infections, from the hospital to you. According to the Centers for Disease Control, hospital-acquired infections affect 1.7 million people every year. These include pneumonias, infections around the site of surgery, urinary infections from catheters, and bloodstream infections from IVs. Such infections often involve bacteria that are resistant to many antibiotics, and can be deadly (the CDC estimates nearly 100,000 deaths due to them every year), especially to those with weakened immune systems.
#8. Not-so-accidental “accidents”. Every year, 500,000 patients “fall” while in the hospital. Just as many “accidents” occur due to malfunctioning medical devices. Defibrillators don’t shock; hip implants stop working; pacemaker wires break. There are supposed to be safeguards to prevent these problems from happening, but even if they happen in 1 in 100 people, do you want to be that one person who experiences the “accident”?
#9. Missed warning signs. When patients get worse, there is usually a period of minutes to hours where there are warning signs. You may feel worse, and there are often changes in your heart rate, blood pressure, and other measurements. Unfortunately, these warning signs are frequently missed, so that by the time they are finally noticed, there could have been irreversible damage.
#10. Going home?—not so fast. Studies show that 1 in 5 Medicare patients return to the hospital within 30 days of discharge from the hospital. This could be due to patients being discharged before they are ready, without understanding their discharge information, without adequate follow-up, or if there are complications with their care. The transition from hospital to home is one of the most vulnerable times, and miscommunication and misunderstanding can kill you after you get home from the hospital too.
Hospitals recognize these medical errors as a significant problem, and they are taking steps to make care safer.
These new estimates were developed by John T. James, a toxicologist at NASA‘s space center in Houston who runs an advocacy organization called Patient Safety America. James has also written a book about the death of his 19-year-old son after what James maintains was negligent hospital care.
By extrapolating across 34 million hospitalizations in 2007 combined with his findings, James concluded that preventable errors contribute to the deaths of 210,000 hospital patients annually.
That is the baseline. The actual number more than doubles, James explains, because the trigger tool doesn’t catch errors in which treatment should have been provided but wasn’t. It’s known that medical records are missing some evidence of harm and diagnostic errors aren’t captured.
An estimate of 440,000 deaths from care in hospitals “is roughly one-sixth of all deaths that occur in the United States each year,” James wrote in his study. He also cited other research showing that hospital reporting systems and peer-reviews capture only a fraction of patient harm or negligent care.
Many doctors, researchers and scientists agree with the evidence presented by John T. James. Three prominent patient safety researchers reviewed James’ study and all said his methods and findings were credible.
Dr. Lucian Leape, a Harvard pediatrician who is referred to as the “father of patient safety,” was on the committee that wrote the “To Err Is Human” report. He has confidence in the studies and the estimate by James.
Dr. David Classen, said the James study is a “great contribution.” He said it’s important to update the numbers from the “To Err Is Human” report because in addition to the obvious suffering, preventable harm leads to enormous financial costs.
Dr. Marty Makary, a surgeon at Johns Hopkins Hospital whose book Unaccountable calls for greater transparency in health care, said the James estimate shows that eliminating medical errors must become a national priority. He said it’s also important to increase the awareness of the potential of unintended consequences when doctors perform procedure and tests. The risk of harm needs to be factored into conversations with patients, he said.
Leape, Classen and Makary all said it’s time to stop citing the 98,000 number.
Dr. David Mayer, vice president of quality and safety at Maryland-based MedStar Health, said people can make arguments about how many patient deaths are hastened by poor hospital care, but that’s not really the point. All the estimates, even on the low end, expose a crisis, he said. “Way too many people are being harmed by unintentional medical error,” Mayer said, “and it needs to be corrected.”
What’s the right number? Nobody knows for sure. There’s never been an actual count of how many patients experience preventable harm. So we’re left with approximations, which are imperfect in part because of inaccuracies in medical records and the reluctance of some providers to report mistakes.
This might sound to some that we are bashing doctors. Actually, we respect those in the medical profession. They are some of the most caring and dedicated people in the world. They give and give and give to their patients.
The problem isn’t the medical staff but rather their patients. If people would only build stronger immune systems and live healthier lifestyles they wouldn’t be so susceptible to the diseases many are experiencing. We can blame the medical establishment all we want but they aren’t the ones who are consuming the wrong foods and exposing themselves to unhealthy substances. They are just the ones left with trying to fix the problems.
So, keep your immune system strong and avoid the next medical crisis that might lead to you becoming one of the statics. And, if you are currently fighting something – change things now. Å strong immune system will not only keep you healthier in the hospital it will help your body heal.
Is it any wonder that Dr. Malkmus has spent the better part of his life trying to convince people that “You don’t have to be sick?”