Map of life expectancy at birth from Global Education Project.

Wednesday, September 26, 2012

Medical Nemesis

I'll largely outsource today to Marshall Allen, who reviews the evidence that some unknown hundreds of thousands of people are harmed each year in the United States by medical errors. He bemoans that we don't keep track of all these errors, ergo it's hard to know how to fix them.

Okay, but his main premise is that people who are harmed by medical errors don't take advantage of the systems that are available to report them. That's just ridiculous. In the first place, most people have never heard of these systems. (Basically, you can complain to your state medical licensing board, and if you're a Medicare beneficiary, your state has what's called a Medicare Quality Improvement Organization.) Even if they have, most of the time they have no idea that they were harmed by a medical error, unless the doctor told them, which obviously isn't likely to happen.

If they do know it, or believe it, they might sue, but just making a mistake isn't enough to get a doctor successfully sued -- they have to be negligent, which is a whole other level. And who's going to go to the trouble of tracking down how to complain to the state licensing board? Especially since the truth of the matter is, the board won't do anything with your complaint anyway.

Hospitals are supposed to report certain categories of errors, but they don't. And how are you going to make them do it?

This is really a problem of the culture of medicine. Doctors make mistakes, they're human, and so do nurses and pharmacists. But we have had fewer and fewer plane crashes over time and now flying is safer than hanging out at home. We got there through a concerted effort by regulators and yes, the airline industry, which doesn't like plane crashes any more than you do. Of course, we don't have to worry about crashes being reportable, but the industry also documents errors that don't actually lead to crashes, as well as reverse engineering every crash that does happen and, at least eventually, fixing the problems that led to it on a systems level. Medicine can do that too.

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