The most common causes of death in the United States (US) are annualized by the Centers for Disease Control and Prevention (CDC). Public awareness is informed by this report and it also guides the outline of research priorities and in part, funding. However, there are limitations to the current process of identifying causes of death. Makary and Daniel from Johns Hopkins recently published a critically significant paper describing the current conundrum and establishing that after heart disease and cancer, medical error is the third leading cause of death in the US.1
Currently, the list of common causes of death results from death certificates completed by physicians, funeral directors, medical examiners and coroners in which an International Classification of Disease (ICD) code is assigned based on the cause of death. Any cause of death that does not have an ICD code - such as a human or system factor - is not identified within the current coding process. Of interest is that 117 countries use this mechanism to determine their mortality statistics. Even when an in depth attempt is made to purposefully extrapolate medical errors (such as in statewide surveys), outpatient records such as those in clinic settings and ambulatory surgery, and nursing home records are not included in the analysis.
Makary and Daniel evaluated the current scientific medical error literature to quantify its contribution to US deaths.1 Analyzing the Harvard Medical Practice Study in the 1980s, the Utah and Colorado studies in the 1990s, the 1999 Institute of Medicine (IOM) report, and deaths among Medicare beneficiaries, the authors concluded that our current estimation of deaths resulting from errors is severely underestimated. In fact, it translates to over four times the IOM estimate, namely 400,000 deaths a year making it the third most common cause of death in the US.
While determination of the role of error in death causation is complex, the authors advise that our current system has limited ability to capture most types of medical error. A new profiling paradigm is urgently needed. Additionally, they stated that while human error is inevitable, three strategies should be implemented to reduce death from human error:
- Make errors more visible when they occur so their untoward effects can be intercepted.
- Have immediate remedies at hand to rescue patients.
- Make errors less frequent by following principles that take human limitations into account.
Our specialty is one characterized by risk. Our patients often come to us in a compromised state and we treat them with toxicity-laden therapies unlike that seen in any other specialty. We should endeavor to maximize our efforts to reduce human error often related to intense and often interrupted communication and heavy workload (both emotionally and physically). We owe it to our patients who already face the limitations incurred by an overwhelming life-threatening illness.
- Makary MA, Daniel M. Medical error--the third leading cause of death in the U.S. BMJ, 2016 May 3;353:i2139.