Near the end of 1999 the Institute of Medicine released what at the time was a rather controversial, certainly disturbing report entitled “To Err is Human”. What they did was simple – count how many Americans die every year as a direct result of errors that doctors and other healthcare providers make in the treatment of patients in American hospitals. The total they counted up created a stir that is still felt ruffling the feathers of doctors around the world today.
In case you missed it in the media, that number was somewhere between 44 000 on the low end and 98 000 on the high end. Why such a big range? Surely they could count better than that? The reason for the big range is that the total depends on your inclusion criteria, which is a technical way of saying what exactly do you count as a mistake?
The IOM was looking at things doctors actually did that were the wrong things to do, but also at things they really should have done, but didn’t, and as a result someone died. The key is that they were counting things doctors did or didn’t do that directly caused death – and cause is quite a difficult thing to be certain about. Can you be certain that something that doctor did was the actual cause of that patient dying? Sometimes you can, but in other situations there is some doubt. If you are very strict and only include more certain cases of cause, then the number is 44 000. If you are a bit looser in your definition and allow for a bit of possible doubt, then the number is 98 000.
So how bad are these statistics? Well, lets do some comparisons…
Even using the low end very conservative number (which probably is a bit too low), it means doctors kill more people in hospitals than cars kill people on the roads. That’s bad enough. But it also means doctors kill more people than breast cancer and you know what a massive awareness and intervention effort that illness receives. It also means doctors kill more people than commit suicide – in fact if you use a figure halfway between 44 and 98 000 it means doctors kill about two people for every one that commits suicide. That feels profoundly uncomfortable somehow. Diabetes kills 68 000 Americans every year, about the same as doctors. The American Diabetes Association, just one diabetes-orientated organization, declared just over $200 million worth of funding to fight these deaths in 2010. The Centres for Disease Control spend close enough to that amount of federal funds themselves, fighting diabetes.
But the most chilling comparisons come from aviation and finally war.
If pilots were as bad as doctors in hospitals it would mean that a Boeing 747 loaded full of passengers would be crashing every second day, killing everyone on board. How keen would you be to fly? And is it conceivable that passenger aviation would continue? Even one accident today, of one aircraft, even if nobody actually dies, can ground an entire operator’s fleet, or an entire aircraft type, while the incident is investigated. Accidents are just not acceptable.
In 1960 John F. Kennedy assumed the presidency and soon focused on the problems in Vietnam as an opportunity to reverse recent losses and beat communism. Troops were sent to the area but only numbered around 16 000 in 1963. In 1965, well after Kennedy’s death and with Lyndon Johnson at the helm and committed to escalating the effort, US Marines were dispatched. By December 1965, 200 000 Marines were actively engaged in the conflict. Therefore although the conflict actually began in the mid 1950’s, the real commitment of personnel and the overt military action really got underway in 1965. The conflict hit a peak around the time of the Tet offensive in 1968. By 1972 and largely because of severe communist losses at Tet, Nixon had been able to initiate and continue strategic withdrawal of troops for three years, even though fighting continued. The elections of 1972 and the Paris Peace Accord both pushed forwards the de-escalation of conflict. It ended finally in 1973.
So we have eight years of out and out war. In those eight years 58 220 Americans were killed. That’s about 7 300 a year, give or take. Its a horrible statistic, every year, year in and year out. But it absolutely pales in comparison to nearly 100 000 Americans being killed every year. Even if we take the most narrow and biased look and throw out the years of de-escalation under Nixon and just focus on Johnson’s big three years from 1966 – 1968, the figures are 30 000 Americans killed under Johnson’s reign. That’s 10 000 Americans dead every year. And that is as bad as we can possibly make the statistics from the Vietnam War.
That means that deaths from medical error are ten times worse than those from the Vietnam war.
There is no other way to put it really. Now consider the enormous social movement that evolved to protest against the war in the 1960’s and early 70’s. The huge social awareness. The emotion and passion and energy and tie and effort. Remember the nearly half a billion dollars spent annually on prevention of diabetes. Consider the detailed complexity of aviation safety efforts. Doesn’t it leave you with a bit of a cold shiver up your spine when you think of doctors killing up to 100 000 people in hospitals every year – and it is really tough to find anything much being done about it?
And that’s just hospitals.
Those numbers only count deaths in hospitals. What about mistakes made by doctors outside of hospitals? There is some thought that these may be even greater.
And of course those are American numbers. It is a lot worse in third world countries – the really scary part is that we have no idea how bad it really is. There’s a war going on and we don’t even know how many people are being killed. That’s not ok.
Make no mistake – it is a war. A war against error. It’s one taking a terrible toll on human lives every day. It affects your family, your friends and one day perhaps you yourself. The first step is to be aware. If Americans had not heard about the 7000 dying each year, there would have been no protests, no public pressure, no anti-war movements and perhaps things wouldn’t haven’t changed much, for quite a long while.
But things did change there and they can here. But you need to know about it.