Headline on Yahoo! News last night (unrelated to Donald Trump) was “Medical error – the third leading cause of death in the US.” The article focused on a newly published article in the British Medical Journal, Makary MA, 2016:353:i2139 with the same title. Actually reading the article is much more enlightening than the headline. Contrary to the headline, the ultimate premise of the article is that the United States needs to adopt a uniform method of reporting deaths so that science can develop a true estimate of the number of “preventable” idiopathic (i.e., related to medical care) deaths. In fact, the authors admit that their headline is an estimate that needs “greater attention.”
The article starts off by defining “medical error” as “an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient.” This appears to be significantly broader than the definition of professional malpractice or medical negligence under the laws of most states. The authors then point out the obvious: death certificates provide inadequate information to use as a reliable source for determining whether a death is or is not related to a preventable medical error. Notably, the authors are sharp to alert readers that death certificates may not be completed by a medical professional of any kind and could include laypeople, such as funeral directors.
The authors devoted a significant amount of time to parsing through the myriad of “studies” published since the 1999 Institute of Medicine report, To Err is Human. The take-home message is that each of the studies involved a significant amount of statistical extrapolation. It is beyond the scope of this post to dive into whether the methodology of those studies was flawed.
The ultimate take-home message, buried in the middle of the article, is “deaths caused by errors are unmeasured.” The authors offer some useful suggestions to collect quality data so that a true estimate can be performed. Until then, the headline is likely to prevail.