Doctor Challenges Medical Errors ‘Hysteria’

A report calling medical errors the third leading cause of death has serious flaws that make that conclusion invalid, according to a physician. He says the report contributes to an irrational hysteria over medical errors.

The analysis in The BMJ received significant attention in the general media and within the healthcare industry, but it actually does not show such an impact from medical errors, says Gerard Gianoli, MD, FACS, a neuro-otology and skull base surgeon, and a clinical associate professor at Tulane University School of Medicine in New Orleans. Gianoli recently published a critique of the BMJ report in The American Journal of Medicine (AJM). (The AJM article can be accessed online by going to the website http://bit.ly/2anG1cH.)

Gianoli says the BMJ report was “inflammatory,” “sensationalist,” and that it was an opinion piece rather than a scientific study.

The BMJ report was the result of analyzing data after 1999 to determine a mean rate of medical error-related deaths at 251,454 per year. That rate was factored into the total number of U.S. hospital admissions in 2013, and, using those figures, medical errors were the third most common cause of death in the United States.

Documentation of Errors

The study was led by Martin Makary, MD, MPH, FACS, professor of surgery and health policy & management at Johns Hopkins University School of Medicine in Baltimore, MD. (The BMJ report can be accessed by readers online at http://bit.ly/1rtW6Sa.) Healthcare Risk Management (HRM) requested comment on Gianoli’s criticism but did not receive a response from Makary.

The report also said that medical errors are not well documented in death certificates, and the researchers suggested that a new field be added to the certificates asking if the death was related to an avoidable complication of medical care.

Gianoli says the “third leading cause of death” claim is invalid because the number of patient deaths analyzed over 10 years was only 35.

“The paper simply states the average of three previously published studies and one paper that was never vetted through the peer review process — all published more than eight years ago,” Gianoli says in the AJM report. “All four of these papers include a combined analysis of a grand total of only 35 actual patients, from which the authors extrapolate to 251,454 deaths due to medical errors in the U.S. every year. This is a highly dubious estimate.”

Errors Don’t Always Kill

Gianoli tells HRM that he also questions how medical errors were defined for the analysis. Some deaths attributed to medical error were not caused by the error itself, he says. Even if a significant medical error occurred in the process of caring for the patient, it may have had no effect on the outcome, he says, but it might still be classified as “medical error-related.” In other cases, a known potential complication can be misclassified as an error.

“When a patient was sent home from an emergency room in Dallas with Ebola last year, this was an error probably caused by electronic medical record-related disruption. The patient later returned and died. But he probably would have died even if this systems error had not occurred,” Gianoli says in the paper.

Gianoli takes issue with the one case presented in the BMJ article. It concerns a patient who died of complications from pericardiocentesis, a procedure in which the surgeon inserts a needle into the sac around the heart. The procedure is risky, and complications are not unexpected, Gianoli says. The complication can occur without any overt error by the surgeon, he says.

The conclusions of the report are overstated because death would be inevitable in many cases without medical intervention, he says, and the margin of error in critically ill patients is often razor thin.

Gianoli thinks the BMJ article could contribute to an excessive focus on medical errors, which makes it “the silicone breast implant hysteria” of our generation. In the 1980s and 1990s, extensive media coverage and fearmongering about silicone breast implants resulted in many being removed without medical justification, and plaintiffs’ attorneys benefited. A maker of the implants, Dow Corning, went bankrupt, and a moratorium was placed on the use of silicone, which kept it from patients who needed breast cancer reconstruction. Years later, medical research established that the fears were unfounded and silicone implants are safe.

Gianoli says he doubts the BMJ report will result in fewer medical errors, but he says that it could have a negative effect on healthcare if it leads to more administrative requirements and data collection. Healthcare professionals are willing to admit their errors and improve, Gianoli says, but he characterizes the BMJ report as “self-serving, irresponsible sensationalism by Monday-morning quarterbacks.”