How to Grade Male Pattern Hair Loss and Find a Board Certified Transplant Surgeon

Before one undergoes a hair transplant surgery, they will want to know how to classify the hair loss.


Federation of State Medical Boards FCVS Considerations

CORRESPONDENCE FROM THE INTERNATIONAL SOCIETY OF HAIR RESTORATION SURGERY REGARDING CONCERNS OVER UNLICENSED PERSONS PERFORMING HAIR TRANSPLANT SURGERY The Board reviewed the correspondence from the International Society of Hair Restoration Surgery regarding concerns over unlicensed persons performing hair transplant surgery.

 

doctor-3

legally-perform-hair-restoration-surgery
I am aware and I do not care. I do not trust persons who try to create monopoly while using the term “patient safety” in a self-serving manner.
How to Grade Male Pattern Hair Loss and Find a Board Certified Transplant Surgeon

Links to Every State Medical Board

The links are below, but first consider

Patient L.T. died from gross negligence four hours after the nurse gave him seven different medicines intended for a seizure patient. LT was on dialysis and cpuld not excrete the thousands of milligrans of gabapentin and other sedating medicines. Instead of preventing this from occurring again by training the nurse to follow the standard-of-care, Dr. Jeffrey Carter MD, Kevin O’Malley JD, David Poggemeier MD, and the other Missouri Medical Board members chose to spend two years in a failed effort to blame Dt. Surendra Chaganti for the death. The aformentioned SMB members never apologized for that or for their failed five year effort to punish Dr. Chaganti for a clerical error on a job application.

O’Malley, Poggemeier, and Dr. James DiRenna are bureaucratic who caused an Honorable Administrative Law Judge Sreenu Dandamudi to write on court records that the State Medical Board of Missouri Misrepresented EvidenceExternal Linkin a failed effort to fraudulently revoke the medical license of Dr. Antoine Adem .

Links to Every State Medical and Osteopathic Board:

Alabama Board of Medical Examiners and Medical Licensure Commission of AlabamaExternal Link

Alaska State Medical BoardExternal Link

Arizona Medical BoardExternal Link

Arizona Board of Osteopathic Examiners in Medicine and SurgeryExternal Link

Arkansas State Medical BoardExternal Link

Medical Board of CaliforniaExternal Link

Osteopathic Medical Board of CaliforniaExternal Link

Colorado Medical BoardExternal Link

State of Connecticut, Department of Public HealthExternal Link

Delaware Board of Medical Licensure and DisciplineExternal Link

District of Columbia Board of MedicineExternal Link

Florida Department of Health, Division of Medical Quality Assurance (MDs)External Link

Florida Department of Health, Division of Medical Quality Assurance (DOs)External Link

Georgia Composite Medical BoardExternal Link

Hawaii Board of Medical ExaminersExternal Link

Idaho State Board of MedicineExternal Link

Illinois Department of Professional RegulationExternal Link

Medical Licensing Board of IndianaExternal Link

Iowa Board of MedicineExternal Link

Kansas State Board of Healing ArtsExternal Link

Kentucky Board of Medical LicensureExternal Link

Louisiana State Board of Medical ExaminersExternal Link

Maine Board of Licensure in MedicineExternal Link

Maine Board of Osteopathic LicensureExternal Link

Maryland Board of PhysiciansExternal Link

Massachusetts Board of Registration in MedicineExternal Link

Michigan Board of MedicineExternal Link

Michigan Board of Osteopathic Medicine & SurgeryExternal Link

Minnesota Board of Medical PracticeExternal Link

Mississippi State Board of Medical LicensureExternal Link

Missouri Board of Registration for the Healing ArtsExternal Link

Montana Board of Medical ExaminersExternal Link

Nebraska Board of Medicine and SurgeryExternal Link

Nevada State Board of Medical ExaminersExternal Link

Nevada State Board of Osteopathic MedicineExternal Link

New Hampshire Board of MedicineExternal Link

New Jersey State Board of Medical ExaminersExternal Link

New Mexico Medical BoardExternal Link

New Mexico Board of Osteopathic Medical ExaminersExternal Link

New York State Board for MedicineExternal Link

North Carolina Medical BoardExternal Link

North Dakota State Board of Medical ExaminersExternal Link

State Medical Board of OhioExternal Link

Oklahoma Board of Medical Licensure and SupervisionExternal Link

Oklahoma State Board of Osteopathic ExaminersExternal Link

Oregon Medical BoardExternal Link

Pennsylvania State Board of MedicineExternal Link

Pennsylvania State Board of Osteopathic MedicineExternal Link

Rhode Island Board of Medical Licensure and DisciplineExternal Link

South Carolina Board of Medical ExaminersExternal Link

South Dakota Board of Medical and Osteopathic ExaminersExternal Link

Tennessee Department of HealthExternal Link

Tennessee Board of Ostepathic ExaminationExternal Link

Texas Medical BoardExternal Link

Utah Division of Occupational and Professional LicensingExternal Link

Vermont Board of Medical PracticeExternal Link

Vermont Board of Osteopathic PhysiciansExternal Link

Virginia Board of MedicineExternal Link

Washington State Medical Quality Assurance CommissionExternal Link

Washington Board of Osteopathic Medicine and SurgeryExternal Link

West Virginia Board of MedicineExternal Link

West Virginia Board of OsteopathyExternal Link

State of Wisconsin Medical Examining BoardExternal Link

Wyoming Board of MedicineExternal Link

Patient L.T. died from gross negligence four hours after the nurse gave him seven different medicines intended for a seizure patient. LT was on dialysis and cpuld not excrete the thousands of milligrans of gabapentin and other sedating medicines. Instead of preventing this from occurring again by training the nurse to follow the standard-of-care, Dr. Jeffrey Carter MD, Kevin O’Malley JD, David Poggemeier MD, and the other Missouri Medical Board members chose to spend two years in a failed effort to blame Dt. Surendra Chaganti for the death. The aformentioned SMB members never apologized for that or for their failed five year effort to punish Dr. Chaganti for a clerical error on a job application.

Medical Board Members sneaky
Medical Board Investigator willing to win his case against a doctor at any cost. He is planning and plotting how to conceal evidence and make his department look good.
Medical Board Bureaucrats made false promises.
MedicalnBoard Members vowed to protect the public, but instead exploited killed patient LT, lied about care of breast cancer patients, and

issues related to job applications.

Links to Every State Medical Board

Missouri State Board of Healing Arts Ethics Complaint

Dear Missouri Ethics Commission,

Ethics Complaint Fell on Deaf Ears

State Board of Registration for the Healing Arts of Missouri
Systematic Dysregulation of Public Safeguards and Potential Solutions

This ethics complaint is being filed against the Missouri (MO) State Board of Registration for the Healing Arts (SBRHA),1 the SBRHA Executive Director Connie Clarkston, and the SBRHA Attorney – Counsel, Frank Meyers, JD. This complaint is structured into 10 major areas of unethical regulatory conduct. Each section contains this writer’s opinion regarding what the SBRHA should do to correct their unethical conduct, and this is described in a manner that illustrates the nature of the unethical conduct. Many of the SBRHA’s unethical actions continue to cause harm as they have propagated disinformation about patient care and they refuse to acknowledge their publicly filed false claims. The SBRHA refuses to tell the truth about cancer testing and unnecessary surgery – important aspects of care which they already filed lies about in court. By concealing the truth about patient care and punishing honesty, the SBRHA committed acts which are the exact opposite of their legislated duty. The SBRHA has a responsibility to address the numerous instances of unsafe and unethical conduct committed by their licensee Dr. Kamani Lankachandra (Dr. KL) e.g. she provided disinformation to the ACGME about months of patient care, committed perjury in her April 2014 deposition about unnecessary surgery, misrepresented Dr. Snodgrass’s 2011 academic status at UMKC in a Spring, 2013 postgraduate reference letter that she sent to the Georgia Composite Medical Board, and she committed perjury when she testified under oath on about July 2nd or 3rd, 2014. Residents at UMKC that were placed on probation were supposed to, per university policy, be able to appeal the decision. Dr. KL was asked why she wrote Dr. Snodgrass was on probation on about 12 29 2010. A few minutes later she said, still under oath, that probation and remediation are the same, something that is not supported by the subsequent testimony of Dr. Jill Moormeier, which occurred less than two hours after the court teleconference with Dr. Lankachandra. Dr. Moormeier is UMKC’s Accreditation Council on Graduate Medical Education (ACGME) Designated Institution Official (DIO), and she is the leader in charge of the residency programs at UMKC.

In addition to witnessing Dr. KL commit perjury during court, the SBRHA reviewed Dr. Snodgrass’s resident evaluations created by Dr. KL and discovered numerous bizarre and incompetently documented assessments of Dr. Snodgrass, and yet they remained complicit in enabling her incompetent resident evaluations. Dr. KL’s written evaluations often contained vague, harsh criticism; e.g. she wrote claims stating that Dr. Snodgrass lacked energy, that he blamed others, and that he refused to learn. There was not a single example documented to illustrate any of the aforementioned claims from April 2011. Furthermore, Dr. KL’s incompetently documented resident assessments were not limited to April 2011. The SBRHA acted unethically by (1) identifying the aforementioned bizarre documentation but not disciplining Dr. KL’s medical license for incompetence and then by (2) filing the incompetent assessments in court as if they were legitimate. Instead of addressing Dr. KL’s dishonesty or areas of demonstrated incompetent documentation, the SBRHA acted unethically by concealing the dishonesty. Furthermore, the SBHRA violated professional ethics even more by punishing Dr. Snodgrass for his true reports about unsafe patient care.

The SBRHA failed to address the dishonesty and corruption, the routine lying about academic matters as well as patient care, and they have punished a physician for honestly reporting unsafe patient care. Please provide your kind consideration to the following four sections of this complaint (1) the overview of the complaint, (2) the details of the complaint, (3) the references, and (4) the enclosed supplementary materials.

Overview of the 10 aims – the SBRHA should

I. Acknowledge the lies about months of reckless breast cancer testing and that they did not disclose this to their recent auditor – who gave them a rating of “good.”

II. Acknowledge that Dr. Snodgrass faithfully reported several patient care standards violations to The Joint Commission2 in 2012 and that it was unethical for the SBRHA to exploit unsafe patient care to berate him as a liar during his 2014 trial.

III. Acknowledge that Dr. Kamani Lankachandra (Dr. KL) made false claims about Dr. Snodgrass’s academic status in 2013 and 2014 to different state medical boards. The false claims appear to be disparate to each other, i.e. inconsistent and were related to whether Dr. Snodgrass was on probation or remediation when he was at UMKC.

IV. Acknowledge Dr. Snodgrass completed 44 months of ACGME accredited training,3 and that Dr. KL made misleading claims in 2013 to the MO SBRHA regarding her ability to document his clinical competency. It was unethical of the SBRHA to contest this, and it was unethical of them to refuse to accept prior documentation of training as well as for them to refuse to address the dishonesty of Dr. KL. In her letter written on May 25, 2011, Dr. KL documented the quality of Dr. Snodgrass’s patient care as appropriate for his level of training and that he completed 34 months of pathology training. However, in the fall of 2013, when Dr. Lankachandra was asked to document Dr. Snodgrass’s clinical competency on a different form, the Postgraduate form provided by the SBRHA, Dr. Lankachandra wrote that she was unable to answer the question of whether he was clinically competent because he left the residency program (June 27, 2011). Dr. Lankachandra could have informed the SBRHA that she documented the same information about patient care on the form that she signed on May 25, 2011.

In contrast to Dr. Lankachandra’s sudden inability (2013) to report that Dr. Snodgrass was competent for his level of training, she maintained her ability to write negative statements about him.

Dr. Lankachandra was able to evaluate Dr. Snodgrass’s performance negatively in several other areas such as his professionalism and his work with peers.

Connie Clarkston and Frank Meyers, JD, were informed about the postgraduate training letter signed on May 25, 2011 by Dr. Kamani Lankachandra. Instead of addressing the highly questionable evaluations made by Dr. Lankachandra, Ms. Clarkston and Mr. Meyers repeatedly berated Dr. Snodgrass as incompetent.

Dr. Snodgrass in other performance domains such as his interactions with peers.

It was unethical of the SBRHA to facilitate this additional dishonesty and refuse to redress it. The SBRHA should acknowledge the deception and apologize for abusing discretion and relying on a doctor who committed perjury (April 2014 and July 2014) to assess Dr. Snodgrass while concomitantly rejecting the earlier letter Dr. Lankachandra wrote, a letter which contained information that answers the critical question about physician competency on the SBRHA’s postgraduate training form.

In retrospect, Dr. Snodgrass should have had Dr. Lankachandra sign and mail the “SBRHA’s postgraduate training form” in 2011. Given that Dr. Snodgrass had witnessed Dr. KL make numerous false claims in evalautions during residency training, he did prudently ask the UMKC GME Office run by Dr. Jill Moormeier to store the “ACGME Postgraduate training form.”

The SBRHA should not change their assessment of the quantity of training because a pathologist who committed perjury changes her mind.

 

 

V. Acknowledge that the April 2014 deposition of Dr. KL contained multiple false claims about patient care.

VI. Acknowledge that it was unethical for the board members to have Connie Clarkston, the SBRHA’s Executive Director, to communicate shocking news via only formal letter without any competent explanation. Ms. Clarkston wrote Dr. Snodgrass an official letter on 11 20 2013 with instructions to obtain a ($10,000) multidisciplinary evaluation without specifying why, other than the bizarre and unfounded belief that such an evaluation could be “very insightful.”4 It was grossly unethical to communicate shocking information in such a manner and without competent rationale. These acts of dysregulation are discussed further in the detail section of this report.

VII. Acknowledge that the SBRHA demonstrated numerous instances of unethical conduct against the cardiologist Dr. Antoine Adem. The SBRHA should implement a plan to prevent similar misconduct from occurring in the future.

VIII. Acknowledge that the SBRHA committed numerous unethical and incompetent acts against the psychiatrist Dr. Surendra Chaganti. The SBRHA should devise a plan to prevent similar unethical conduct from occurring in the future. For example, many medical boards might ensure that the board members know how to read FDA drug labels and identify that Marinol is acceptable for use in elderly patients.

IX. Acknowledge that it was unethical to show partiality by trusting a pathology program director who lied under oath in court. According to Johnson and Chaudhry, state medical board members should have a passion for the judiciary, and that means the board members should evaluate reports of patient harm without showing partiality.5 Being a program director who commits perjury does not mean that one’s expertise in looking at cells under the microscope transfers to an increase in integrity and honesty. The SBRHA appears to have a conflict of interest related to their plans to build collegial relationships with medical school deans in order to increase the primary care workforce and their refusal to uphold the statutes as it relates to a physician who is a department chair and program director at one of those universities. It is unethical for the SBRHA to selectively enforce the statutes and enable some doctors to be above the law, to commit perjury repeatedly about patient care and then for the SBRHA to help conceal the dishonesty. If the SBRHA Board Members had a passion for the judiciary as Johnson and Chaudhry assert is important for board members, then they probably would be more concerned with the truth about patient care and stop exploiting patients who were harmed or received unnecessary surgery in order to conceal the errors and dishonesty of a physician who has significant clout at the university.

X. Acknowledge that the phrase “lives are at risk,” does not justify the SBRHA’s repeated acts of lying about patient care. The SBRHA should acknowledge that repeatedly lying about patient care does not improve the integrity of the profession, does not make patients safer, and may decrease patient safety.

 

Details of the 10 categories of ethical complaints including suggestions for consideration

I. The SBRHA should acknowledge that the breast cancer specimens at the UMKC Pathology Department were routinely subject to prolonged ischemic times from January-to-June 2011. The SBRHA should apologize for wrongfully exploiting months of unsafe patient care in an effort to punish Dr. Brett Snodgrass for his credible and accurate reports to regulators such as the ACGME.6 The SBRHA should apologize for not addressing UMKC’s lies about breast cancer testing as well as for filing the false claims in court against Dr. Snodgrass on July 3, 2014.

The SBRHA used their state-given investigative authority to prevent evidence of their dishonesty from being evaluated by the auditor. The SBRHA did not disclose that they have enabled a physician to repeatedly commit perjury, that they filed many lies about patient care into court, and that they still, as of March 1, 2016, refuse to tell the truth about the months of reckless breast cancer testing.

According to the American Society of Clinical Oncology, 2010 Guidelines for testing for estrogen receptors on breast cancer specimens, “The time from tumor removal to fixation should be kept to ≤ 1 hour.”

Frank Meyers, JD, withheld the medical records and the allegedly documented breast lumpectomy “ischemic times” from the court. This withholding of medical records from court while filing false claims about patient care in court is unethical and manipulative. It can mislead others to form erroneous conclusions about the quality of care that patients with breast cancer received. Misleading others to believe something that is not true is particularly relevant to the subject of medical regulation. In medical law cases, the burden of proof is not “beyond a reasonable doubt,” but it is “more likely than not.” Thus, one can create a convincing argument by utilizing many lies and withholding the relevant medical records to deceive another person sufficiently to think that the lie is more probable than the truth. Since concrete evidence is not needed in such cases, making false claims about medical facts and patient care in court has been a recurring theme for the SBRHA and has been done against physicians such as Dr. Chaganti, Dr. Adem, and Dr. Snodgrass. This is particularly relevant as the dishonesty and unethical conduct committed against physicians does not merely harm the physician, but it also can harm patients and create an unsafe healthcare system. The dysregulation has helped foster a culture of dishonesty and condoned unsafe patient care. The SBRHA has repeatedly enabled a Missouri physician to lie about patient care as well as academic matters, and they have given no guarantee that there will be a foreseeable end to the dishonesty.

The SBRHA passed their 2015 audit with a rating of “good.” It is worthy of consideration, and possibly further evidence of unethical conduct that the state medical board has used their authority as an investigator of Missouri to conceal or “keep hidden” relevant records regarding patient care. With regards to the SBRHA’s enablement of dishonesty by Dr. KL, and punishing Dr. Snodgrass for his truthful reporting, the SBRHA used their state-given investigative authority to selectively investigate reports of unsafe patient care in order to prevent evidence such as medical records that would prove their dishonesty from being retrieved from TMC and then being evaluated by the auditor.

E. The SBRHA could deceive the auditor either passively or actively. An example of passive deception or tacit collusion would be that none of the SBRHA mentioned that they needed to obtain the reports from TJC to uphold the statutes. This lack of investigation would occur because no member wanted to provide evidence of their dishonesty or the false claims that they filed in court. Active concealment would be having The Joint Commission reports, finding out about the audit, and then shredding them. Hopefully, the dishonest claims about patient care that the SBRHA filed in court are a result of passive deception, which is less deceptive and less unethical. This can occur when the investigators and board members choose not to look for records that they know will likely reveal that the SBRHA has done the opposite of the legislature’s intent.

The SBRHA probably did not want others or the auditor to know about the numerous standards violations that occurred or that Frank Meyers and the SBRHA tried to frame Dr. Snodgrass as having lied to TJC. However, a state agency such as the Missouri Ethics Commission can prove that the SBRHA has been passively or actively concealing numerous records of wrongdoing and dishonesty. A regular citizen can provide no evidence of the dishonesty regarding patient care because the medical records belong to the hospital, and the standards violations are kept out of the hands of the public by The Joint Commission.

The SBRHA did not disclose to the auditor or to the public – in spite of their numerous false claims against Dr. Snodgrass – that they have enabled a physician to repeatedly commit perjury, that they filed the many lies about patient care into court, and that they still, as of March 1, 2016, refuse to tell the truth about the months of reckless breast cancer testing. The board manipulated the evidence – prevented the related medical records and claimed documentation from entering the court, and this may have generated false impressions about patient care. Again, since the burden of proof in medical regulatory cases is “probable cause,” or “more likely than not,” their false claims about patient care are able to create a healthcare culture characterized by deceit instead of the expected integrity and excellence.

The prolonged “ischemic times” for the lumpectomy specimens occurred because the breast tissue would often sit on the counter in the “Gross Room” for more than an hour while waiting to be accessioned by the Gross Room Attendant. Even when a lumpectomy sat on the counter without formalin for less than an hour, the ischemic time could still be greater than an hour because the specimen has to go from the surgical operating room to radiology, and then to the counter top or table until it was accessioned.

Accessioning occurs when a specimen is entered into the pathology computer system and given a specimen number. It was not until after the accessioning that the lumpectomies were permitted to be placed in formalin. Therefore, accessioning of a lumpectomy means that the excised piece of the breast, also known as a lump of breast tissue, is “logged in” to the pathology computer system and given a surgical pathology number. “Ectomy” means to excise or remove, and “lump” is a part of something. Thus the word, “lumpectomy” means to remove a lump, and the words “breast lumpectomy” mean to remove a lump of breast tissue. This is different from a mastectomy where the entire breast is removed.

After being accessioned, the lumpectomy was placed in 10% Neutral Buffered Formalin. The excessive time that the lumpectomy spent sitting on the gross room counter created a normative practice of guideline-discordant care, which is an ischemic period of greater than one hour. Furthermore, the ischemic time was not always less than 30 minutes as the UMKC GME Office misled the ACGME to believe. Sitting on the Gross Room counter waiting to be accessioned and then placed in formalin certainly would not permit an ischemic time of less than 30 minutes, and it is unethical for Mr. Meyers to file such claims in court against Dr. Snodgrass. The SBRHA has a duty to their patients, not a duty to win in court by exploiting patients that received unsafe care. This is grossly unethical as Mr. Meyers exploited unsafe patient care to punish Dr. Snodgrass for accurately reporting reckless cancer testing that he had disclosed twice to Dr. KL and as he also informed Dr. Jill Moormeier in 2011. Even if a lumpectomy only spent 45 minutes sitting on the gross room counter without formalin, the overall ischemic time may be more than an hour. This occurs because after being removed from the patient, the lumpectomy is brought to the radiology department where x-rays are taken to ensure that the tumor was removed. The radiologist looks at the x-ray to make sure that they see the tumor and that the surgeon removed the tumor instead of normal breast tissue. Then the lump of breast tissue would be carried on a radiographic board, usually accompanied by a developed x-ray, in plastic wrap to the Pathology Department at Truman Medical Center.7 Dr. Snodgrass estimates that the mean ischemic time was somewhere between one and two hours.

The importance of minimizing the ischemic time was emphasized in 2010 when additional evidence was published showing that the longer the ischemic interval, the greater the amount of false negative tests for estrogen and progesterone receptors.8 In 2010, the American Society of Clinical Oncology and College of American Pathologists published a guideline recommending that the ischemic intervals should be less than one hour in order decrease the “false negative” testing of the breast cancer for estrogen receptors (ER) and progesterone receptors (PR).9

  • Parenthetically, Dr. Lankachandra had a meeting with the residents in the fourth quarter of 2010, and she informed them about the importance of placing specimens in formalin as soon as possible. Thus, she was concerned about the quality of patient care and took efforts to ensure that the quality was improved. However, she did not appear as concerned about the matter when I informed her, in person, in the gross room, about the prolonged ischemic times in January 2011. After being informed that breast lumpectomy specimens were sitting on the counter without being processed in a timely fashion, she replied that she would address it at the upcoming faculty meeting.

  • The prolonged ischemic time placed the breast lumpectomy specimens at increased

    risk for testing as “falsely negative” for estrogen and progesterone receptors by the test method known as immunohistochemistry (IHC).8 IHC was the method used to test breast cancer specimens for the presence of ER and PR at TMC-HH in 2011. The pathology department sent some of the specimens to an outside lab for additional testing for ER and PR using another method, but there is no guarantee that this method would be performed on the lumpectomy specimens that had the longest ischemic times. The send-out tests were usually carried out on the breast cancers that appeared indeterminate, or in-between the positive and negative cut-off values as determined by the IHC method. If a lumpectomy specimen should have tested as weakly positive if it were given a brief ischemic time, then a prolonged ischemic time could cause that specimen to test as completely negative. Thus, specimens that should have tested as positive may have tested as negative due to the prolonged ischemic times. This particular negligence probably did not cause any deaths, but it may have subjected some women to more aggressive treatment regimens without the benefit of the less toxic hormonal therapies.

N. Regardless, UMKC lied about this testing to the ACGME and the SBRHA punished Dr. Snodgrass for his accurate report to the ACGME by berating him a liar before the Honorable Commissioner. The SBRHA filed UMKC’s blatantly false letter in court to portray Dr. Snodgrass as a liar, and the SBRHA did this at the expense of patient safety and honesty.

O. The UMKC Pathology Department did most of their work at the Truman Medical Center (TMC)– Hospital Hill TMC Pathology Department. The address was

Truman Medical Center – Hospital Hill
2nd Floor Pathology Dept.
2301 Holmes Street
Kansas City, MO 64108

The medical records are electronically preserved, easily accessible, and they belong to TMC.

Due to the recalcitrant nature of the medical board, and their repeated refusal to communicate with me, I reluctantly shared accurate information regarding their regulatory misconduct and that related to the dishonesty about patient care online.10 Mr. Meyers refused to talk with me over the phone as I politely asked him via email in December 2013. The SBRHA exploited patients that received unsafe care and filed false claims against me, at the patient’s expense, in court. Therefore, I shared true and verifiable information online about the unsafe breast cancer care.10 My aim was to provide the public with sufficient information to evaluate the SBRHA’s claims for themselves. Considering that the SBRHA disciplined me for performing my fiduciary duty, and withheld the medical records preventing me from being exculpated about the allegations of lying about breast cancer, I thought it necessary to share truthful information with the public. Patients are therefore able to consider the SBRHA’s publicly filed false claims along with accurate reports of patient care as they evaluate physicians. The SBRHA will assert that this is not professional, but they call lying about patient care professional. Furthermore, patients have a right to evaluate accurate information along with the false claims about patient care that the SBRHA filed in court. The information shared online about the SBRHA’s dishonesty originated in parallel with that of the Veterans Administration Healthcare Scandal of 2014. The scandal at the VA consisted primarily of lies about the “wait times” of ignored veterans. The breast cancer scandal at UMKC and propagated by the SBRHA was predominately related to untruthfulness about the “ischemic times.” of neglected breast lumpectomies.

On July 3, 2014, the SBRHA filed verifiably false claims in court against Dr. Snodgrass regarding months of reckless breast cancer testing that occurred at the UMKC Pathology Department from January-to-June 2011. The SBRHA falsely berated Dr. Snodgrass as a liar for his 2011 faithful report to the ACGME regarding months of reckless breast cancer testing characterized by prolonged ischemic times. The prolonged ischemic times risk false negative tests for estrogen and progesterone receptors, a factor that influences treatment and quality of life, but not overall survival.

Lies filed in court against Dr. Snodgrass in 2014 –Unethical Conduct of Mr. Meyers
Frank Meyers, JD, the Missouri (MO) State Board of Registration for the Healing Arts’ (SBRHA) attorney, was informed in court on about July 03, 2015, that the UMKC Graduate Medical Education Department lied to the ACGME in late 2011 or 2012 about months of reckless and unsafe breast cancer testing at Truman Medical Center – Hospital Hill. In addition, Mr. Meyers witnessed the UMKC Pathology Chair and Program Director, Dr. Kamani Lankachandra, make false claims under oath in court, via telepresence (video conference before the honorable commissioner) on or about July 2 or 3, 2014. Mr. Meyers nonetheless filed her previous deposition claims – from April 2014 in court against Dr. Snodgrass to berate his moral character. It was unethical of Mr. Meyers to rely on the deposition testimony of a known perjurer as evidence to try to punish Dr. Snodgrass and “protect” the public. It was unethical of Mr. Meyers and the SBRHA to permit the dishonesty and to propagate the lies – especially egregious was their propagation of lies about patient cancer care.

Dr. Snodgrass disciplined for reporting unsafe patient care
Systemic dishonesty in healthcare regulation. Neither the LCME, ACGME, nor the Missouri SBRHA opened a single patient chart.

The false claims about breast cancer testing were written by the UMKC GME Office in a letter signed by Dr. Jill Moormeier, to the ACGME around late 2011, or possibly early 2012 – Dr. Snodgrass was not provided with a copy of this letter, but was only shown it during the pre-trial deposition and then asked about it again during the trial. Although the falsified letter about breast cancer testing was signed by the UMKC GME Office’s Dr. Moormeier, it was probably written based on intentionally false information provided by the UMKC Pathology Chair and Program Director, Dr. Kamani Lankachandra (Dr. KL).
1. The lies were written by the UMKC-GME office to Amy Dunlap (married and now her name is Amy Beane) of the ACGME and the letter signed by the UMKC Designated Institution Official (the ACGME-DIO), Dr. Jill Moormeier. The date was in the latter half of 2011 or in early 2012. The SBRHA did not provide Dr. Snodgrass with the letter. Dr. Snodgrass first became aware that the UMKC GME office lied to the ACGME about months of breast cancer testing during his pretrial deposition in June 2014.

2. State agencies can inquiry of Dr. Jill Moormeier and ask how she concluded, as described in her letter written to the ACGME, that the UMKC Pathology Department was often documenting the ischemic time, including during the months of January to June 2011.

T. UMKC made, at least, two lies to the ACGME (in late 2011 or early 2012), and Frank Meyers, JD, of the SBRHA, filed these lies in court against Dr. Snodgrass on July 3, 2014. The lies that were made by UMKC to the ACGME were
1. We always have an ischemic time of less than 30 minutes.

2. The Pathology Department “often [sic]” documents the ischemic time.

U. This is how one can determine that the claims made by UMKC to the ACGME about breast cancer testing were not true:
a. Ask the UMKC Pathology Department to show you the surgical pathology reports of 10 breast lumpectomy specimens from January-to-June 2011 so that you can calculate the mean “ischemic time” to make sure that it was less than 30 minutes as was claimed in the letter to the ACGME.

b. Ask the SBRHA to provide you with the letter that UMKC wrote to the ACGME about breast cancers in 2011.

c. If the SBRHA “lost” the letter, ask the ACGME -acgme.org – or UMKC for it.

V. The SBRHA should acknowledge that forcing physicians into years of litigation with them for reporting months of reckless cancer testing is unethical.4 The transcripts and letters of Snodgrass v. SBRHA are available online at The exhibits were not uploaded by the Administrative Hearing Commission. The letter about breast cancer that UMKC sent to the ACGME was an exhibit, but should be available by contacting the SBRHA, UMKC, or the ACGME. The Shortened URL is http://bit.ly/BoardReform. Full link https://archive.org/stream/Snodgrass-v-SBRHA/Snodgrass%20v%20SBRHA%202013%202014#page/n0/mode/1up

II. The SBRHA should acknowledge that Dr. Snodgrass faithfully reported several standards violations to The Joint Commission (TJC). Also, they should apologize for trying to make his true statements appear as if they were lies. The SBRHA should also acknowledge that the April 2014 deposition of Dr. KL regarding TJC standard violations was not necessarily perjury, but was vague and misleading. The SBRHA should apologize for making Dr. Snodgrass appear as if he were a liar for his faithful and true reports to TJC. Specifically, Dr. KL was not asked if my reports were correct, but she mentioned other, irrelevant information – that the administration at TMC helped her in dealing with TJC.

A. This explains how to determine the claims about The Joint Commission Reports by Dr. Snodgrass were true:
1. Contact The Joint Commission (TJC) on Accreditation for Healthcare and inform them that you are an agency of the state of Missouri. Their website is http://www.jointcommission.org/

2. Ask TJC about the Truman Medical Center Lakewood laboratory and/or pathology department from the first half of 2011 – ask whether there were any standard violations, specifically with reference to the microbiology culture.

3. Inform TJC that you would like to know if Truman Medical Center Hospital Hill laboratory or pathology departments violated any standards in 2011 or 2012. Then you can ask whether a Dr. Snodgrass reported any of those standard violations to them. [Instead of addressing the unethical and unsafe conduct – the state medical board filed Dr. Lankachandra’s April 2014 deposition in court against Dr. Snodgrass – on July 3, 2014 – creating the false impression that Dr. Snodgrass lied to TJC. The SBRHA should apologize for their unethical actions of: (1) failing to protect the public by not addressing TJC standards violations and (2) making Dr. Snodgrass appear as a liar for his veritable reports to TJC.

III. The SBRHA should acknowledge that the UMKC Pathology Chair and Program Director, Dr. Kamani Lankachandra made several false claims about Dr. Snodgrass’s training at UMKC.
A. Dr. KL falsely informed the Georgia Composite Medical Board in 2013 that Dr. Snodgrass was on probation. 

Ethics Complaint Details 

B. The SBRHA should acknowledge that Dr. KL made a significant false claim on the postgraduate training form that she sent to the Georgia Composite Medical Board. She informed them that Dr. Snodgrass was previously on probation at UMKC, and this dishonest act caused Dr. Snodgrass to report her lies to future employers in Massachusetts who then rescinded an internship at St. Elizabeth’s hospital because Dr. Snodgrass was – according to the change in assessment by the UMKC Pathology Chair – on probation while at UMKC.

C. Dr. Kamani Lankachandra (KL) made a false claim in court via telepresence and under oath on about July 2nd or 3rd, 2014, when she claimed that probation and remediation are the same. The DIO Dr. Moormeier testified immediately after her in live court and when she was asked by the Honorable Commissioner Karen Winn whether probation and remediation are the same she replied ~ “Ooh no. They are not the same. Only one is reported to state medical boards. Only probation is reported to state medical boards, remediation is not.” Dr. Lankachandra had been the pathology chair (evaluator of other doctors) and program director (evaluator of residents) by then for four years, but she claimed they were the same. It was unethical for Frank Meyers to witness this additional dishonesty and then continue, without concern that she also lied about patient care in her April 2014 deposition, to file Dr. KL’s lies in court against Dr. Snodgrass.

IV. Acknowledge that Dr. KL made false or misleading claims in writing to the SBRHA in 2013 when she wrote that she could not assess his competency because he left the program even though she already documented nearly identical information in the letter of ACGME Core Competencies.

A. The SBRHA should acknowledge that Dr. Snodgrass completed 44 months of ACGME training – including 12 months of general surgery at Carolina’s Medical Center followed by 34 months of ACGME-accredited training at the UMKC Pathology Department.

B. The SBRHA should acknowledge the training certificate from Carolina’s Medical Center. Connie Clarkston and the SBRHA should apologize for asserting that a quadruply signed document is invalid because a physician that Dr. Snodgrass never met made a negative comment about his performance during his surgical internship. 

Executive Director Connie Clarkston lied to the NPDB and Courts
It was egregiously unethical and deceitful of the Missouri State Board of Registration for the Healing Arts’ Executive Director Connie Clarkston to sign a letter stating that Dr. Snodgrass’s training certificate – which she had – was invalid

 

C. The SBRHA should acknowledge the letter of ACGME Core Competencies signed by Dr. Kamani Lankachandra.

D. The SBRHA should acknowledge that Dr. Snodgrass left the UMKC Pathology Department on June 27, 2011, and that he completed most of his June pediatric surgical pathology rotation – which moves him closer to 45 months of ACGME-accredited training.

E. The SBRHA should acknowledge that lying about patient care and physician competency does not protect the public.

F. The SBRHA should acknowledge that they have failed to evaluate Dr. Snodgrass and other licensees in a competent and equitable manner and that they will establish processes and procedures to prevent similar types of regulatory misconduct in the future.

G. The SBRHA should take steps to ensure that Dr. KL will not continue to make false claims to future state medical boards as she has done once to Georgia and several times to Missouri.

Dishonesty was rewarded by Ms. Clakrston and the Missouri Board of Healing Arts
The state medical board of Missouri enabled Dr. Lankachandra’s lies to be propagated indefinitely and the board did nothing to improve the integrity of physicians.

V. The SBRHA should acknowledge that it was unethical of them to file Dr. KL’s 2014 deposition in court against Dr. Snodgrass without addressing the dishonesty about patient care or the medical misinformation. Dr. KL’s April 2014 deposition appears unethical or incompetent because she claimed that neck dissections are massive procedures and then she said, “I did not cause that.” First, neck dissections are not all massive procedures.11 It was unethical for the SBRHA to witness such a lack of medical knowledge, or incompetence and then file it in court. There are many types of neck dissections, and they are not all “radical neck dissections.” Indeed, Dr. KL’s misdiagnosis of a benign pleomorphic adenoma as a malignant “carcinoma ex-pleomorphic adenoma” resulted, per the surgical pathology log, in a level 2-4 unilateral neck dissection – to check lymph nodes for the spread of the “malignant carcinoma.” The SBRHA acted unethically in this additional instance in several ways. First, the SBRHA did not address Dr. KL’s false claim about the “massive” nature of neck dissections. Second, the SBRHA did not address the dishonesty related to causing a minor neck dissection – the patient did fine regardless, but she lied about it and then referred to Dr. Snodgrass as a liar, another act of perjury.

The state medical board should address physicians who either lie about or do not understand the care that they rendered – a characteristic that Dr. KL demonstrated in her April 2014 deposition. The care occurred on about June 20-22, 2010 and was related to an intraoperative misdiagnosis.

Ms. Clarkston and the Board Members acted lofty, dismissive and were dishonest
Ms. Connie Clarkston of the Missouri Board of Healing Arts was lofty and dismissive. Ms. Clarkston enabled her attorney to file myriad lies about patient care into court.

The SBRHA should review surgical pathology report S-10-003342 from Truman Medical Center Hospital Hill – as well as the associated operative report, and they should consider the operative note, whether the surgeon performed a level 2-4 unilateral neck dissection, and whether Dr. KL’s intraoperative misdiagnosis played a role in causing the patient to receive unnecessary surgery. The SBRHA should evaluate whether Dr. KL’s April 2014 claims of not causing an unnecessary neck dissection and stating, under oath that Dr. Snodgrass lied are consistent with (1) the surgeon’s operative note and (2) the surgical pathology report.

dishonesty is rewarded in Missouri
Did Ms. Clarkston investigate the reports of dishonesty or patient harm in an equitable manner?

The SBRHA should establish means to prevent them from filing false claims about medical information in court in the future. For example, the SBRHA should not propagate misinformation from a senior physician regarding what constitutes a neck dissection.

The SBRHA may have acted unethically by not addressing the lack of competent medical knowledge demonstrated by Dr. KL, in spite of her being the physician who assesses the competency and professionalism of resident physicians.

The SBRHA acted unethically by filing a doctor’s misinformation in court against Dr. Snodgrass while concomitantly asserting that Dr. Snodgrass lacked sufficient training and skills to be licensed as a physician.

VI. The SBRHA should acknowledge that it was unethical for them to instruct Dr. Snodgrass to obtain a multidisciplinary evaluation without specifying why. This $10,000 test was ordered without a reasonable rationale on November 20, 2013.

A. The Missouri State Board of Registration for the Healing Arts instructed Dr. Brett Snodgrass to obtain a multidisciplinary evaluation without specifying the purpose of such an exam – an unfathomable, reckless, unethical, incompetent, and deceptive regulatory practice nearly akin to rectal feedings of patients by CIA Physicians and staff.12 These were acts that allegedly were for safety and security – yet no reasonable person would think that ordering a $10,000 drug evaluation for no stated reason would make sense or that giving food rectally to prisoners would have any benefit of security. This egregious conduct is unethical and illustrates a state medical board that may not be fit to regulate – at least not as they presently are, a deceptive agency that conceals months of patient harm and enables doctors to commit perjury about the care that they provided. Multidisciplinary evaluations are typically used to evaluate drug addictions, and Dr. Snodgrass had already met with the hospital wellness committee in October 2010, where he met with a multidisciplinary panel consisting of the former chair of the UMKC Family Medicine Program, a psychiatrist, and a psychologist. They made no allegation of drug abuse or drug problems and returned Dr. Snodgrass to work in the pathology department with only monthly counseling meetings. The SBRHA should not use state authority to harass people with instructions to obtain bizarre and expensive tests without providing any rationale. This was unethical for the board to do, and it was unethical for Connie Clarkson to write the letter, which can be found on the Board’s website or at the shortened URL http://bit.ly/BoardReform. As the SBRHA’s executive director, Ms. Clarkston should have sufficient experience in the medical field to understand that when physicians instruct patients to get tests or evaluations, there should be a reason. However, she provided no basis for the instruction but nonetheless told Dr. Snodgrass to obtain an expensive, multi-day, in-hospital, multidisciplinary drug evaluation.

B. On November 20, 2013, the SBRHA instructed Dr. Snodgrass to obtain a multidisciplinary evaluation through standard mail only. They did not specify why, and this is an example of poor communication – a dangerous practice for physicians, especially when ordering tests or exams. It is unethical for medical boards to order $10,000 drug evaluations, a type of study where a person goes to live in a hospital for several days while being evaluated for drug issues.
C. Connie Clarkston is significantly responsible for overseeing this unethical conduct. Acknowledge that it was unethical for the board members to have Connie Clarkston, the SBRHA’s Executive Director, instruct Dr. Snodgrass via a formal letter in the mail only, to obtain a $10,000 multidisciplinary clinical drug evaluation without specifying why, other than the bizarre claim of it could be “very insightful.” It was unethical or incompetent for the SBRHA to believe that such an evaluation could be “very insightful,” without specifying how or why any reasonable person would arrive at that conclusion. It was also unethical for the SBRHA’s Executive Director, Connie Clarkston, to write the letter to Dr. Snodgrass with full knowledge that she was not providing a reasonable explanation to establish why Dr. Snodgrass should obtain such an evaluation. Ms. Clarkston, as the executive director of the SBRHA, should understand the importance of there being a clinical rationale for the ordering of clinical evaluations. Furthermore, as the SBRHA’s executive director, she should know that communication is critical to obtaining accurate information from consultants, such as those providers who perform multidisciplinary evaluations.

Paid for incompetence is the status quo in Missouri
The state medical board of Missouri is unnecessarily slow. They are paid to be incompetent, paid to lie, and they are paid to be slow

D. Connie Clarkston’s conduct was, by the professional standards that she probably is familiar with, unethical as well as evidence of negligence or incompetence.

E. If lives are at stake, then Missouri probably needs medical regulators who demonstrate far higher standards than the current SBRHA. If the safety of the public is at stake as the state medical board has argued, then we probably should have a medical board director who is not grossly negligent when they document why they want a particular clinical evaluation. Whether the move to establish safe and competent medical regulators occurs through retraining, firing, or simply apologizing and admitting wrongdoing, the grossly unethical and incompetent regulation should stop.

VII. The SBRHA should acknowledge it was unethical for their agency to commit fraud or gross misrepresentation against the Cardiologist Dr. Antoine Adem and the SBRHA should implement a plan to prevent fraudulent regulation from occurring again in the future.

a. The SBRHA should acknowledge that fraud and misrepresentation do not protect patients, but that it creates an unnecessary burden on physicians who provided excellent patient care. Dr. Adem is one of those doctors, and there is robust evidence that he provided excellent patient care.
b. Please see the enclosed article – which is also found at
i. URL – http://www.esciencecentral.org/journals/novel-insight-into-the-quality-of-assessment-of-physicians-2375-4273-1000155.php?aid=66342

ii. PDF – http://www.esciencecentral.org/journals/novel-insight-into-the-quality-of-assessment-of-physicians-2375-4273-1000155.pdf

VIII. The SBRHA should acknowledge it was unethical of their agency to try to discipline Dr. Surendra Chaganti for providing – “by the books,” “U.S. Food and Drug Administration-approved” excellent patient care. The SBRHA should take measures to ensure that they and their staff know how to read FDA-drug labels. Many physicians would probably take measures to prevent their attorneys from filing blatantly false claims about FDA approved medications in court. Once the SBRHA has established a policy to ensure that the doctors on the SBRHA know how to read FDA drug labels, they should train their staff how to read them including how to identify a drug’s contraindications. Please see attached manuscript describing the SBRHA’s unethical regulatory conduct.

IX. The SBRHA should acknowledge that it is unethical to show partiality to senior physicians in their same profession solely because of one’s academic title. The SBRHA should acknowledge that it was unwise of them to trust the April 2014 deposition of a pathologist, Dr. KL, who lied under oath in court in July 2014. The SBRHA should acknowledge that enabling a doctor who committed perjury to be the main assessor of the professionalism of future physicians is grossly unethical – at least without first acknowledging and correcting the dishonest physician behavior.
A. The SBRHA may have a conflict of interest between their doctors who work at universities and the protection of the public. The SBRHA has previously written on page four of their newsletter that their plan is to work with medical school deans to increase the number of primary care physicians in Missouri.

A Conflict of interest is found in the SBRHA’s April 01, 2015 newsletter http://pr.mo.gov/boards/healingarts/newsletters/2015-04-01.pdf
Facilitating and overlooking repeated dishonesty about patient care by a senior faculty member at a university may be done to strengthen the relationship between the state medical board and the dean of the medical school, something that would be beneficial to the SBRHA’s plans as described on page four of their April 1, 2015, newsletter.13

They permitted a university pathologist to claim she could not evaluate my academic performance in 2013 even though she had already documented nearly identical information on the letter of ACGME Core Competencies from 2011. It is hard to win a court case when the SBRHA repeatedly empowers a dishonest physician to make false claims -even about patient care under oath.

According to the American Medical Association Council on Ethical and Judicial Affairs (AMA-CEJA), physicians should not be silent about the SBRHA’s repeatedly egregious and unethical conduct that is akin to corruptions. Doctors who witness the SBRHA’s numerous instances of unethical actions have a fiduciary duty to speak out against it.14

According to Scutchfield and Benjamin (18th US Surgeon General),
…in the case of physicians’ responsibility to consider the character of their colleagues, the Council (AMA-CEJA) has called on the profession to abandon the “conspiracy of silence” surrounding unprofessional behavior, and has noted, “Incompetence, corruption, or dishonest or unethical conduct on the part of members of the medical profession is reprehensible.”
Furthermore, in dealing with knowledge of a colleague’s misconduct, “A physician should expose, without fear or loss of favor, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.”
Enhancing professionalism and addressing physician misconduct should remain major agenda items for organized medicine, with particular focus on strengthening the medical profession’s responsibility and accountability.15

The SBRHA’s enabling of the Dr. KL to lie multiple times to our medical regulators – even about patient care – is probably considered corruption and is in stark contrast to the recommendations by the previous US Surgeon General. Furthermore, it is the fiduciary duty of physicians such as this author to report and try to stop the unethical conduct of the SBRHA.14

B. The SBRHA should not show partiality to doctors who lie about patient care regardless of academic title, and they should take means to prevent this from occurring again in the future.

X. The SBRHA should acknowledge that lying about months of breast cancer care does not protect the public.
A. The SBRHA should acknowledge that using the phrase, “lives are at stake,” does not grant them a pass to place more lives at stake through reckless and dishonest regulation.

B. Acknowledge that using the phrase “lives are at risk,” does not mean it is okay for regulators of medicine to lie or to be incompetent. Lies about patient care do not protect patients, and the SBRHA should no longer withhold relevant medical records from the courts. The SBRHA should acknowledge that they are not above the law, and they should be held to the same standards as other physicians. The SBRHA members and staff should acknowledge that they are not above the law, and they should establish plans to prevent the egregious regulatory misconduct in the future.

C. The SBRHA should make plans to keep themselves from appearing grossly incompetent or negligent in the future with regard to matters related to patient care and medical knowledge. SBRHA members should acknowledge that evidence-based medicine plays a role in their job. Physicians are appointed to the SBRHA so that they may use their expertise to evaluate the care provided by licensees, but many of the present and all of those that were on the SBRHA from 2010-2014 have repeatedly failed to assess licensees in a competent manner. In contrast, a physician whom they claimed to be incompetent – Dr. Snodgrass – published an article illustrating the SBRHA’s profound lack of medical knowledge and explaining how a competent medical regulator would go about assessing the appropriateness of the coronary artery stent procedures performed by their licensee Dr. Adem.16

D. The SBRHA should acknowledge that it is not appropriate for them to use state resources to discipline doctors that are more competent and knowledgeable than themselves – doctors such as the interventional cardiologist Dr. Antoine Adem and the psychiatrist Dr. Surendra Chaganti.16

Dishonest regulation may be facilitated by assumptions
Making assumptions about important matters of patient care has been Connie Clarkston’s modus operandi.

References

1. Missouri State Board of Registration for the Healing Arts website. Available at: http://pr.mo.gov/healingarts.asp. Accessed March 1, 2016.

2. The Joint Commission. Accreditation, Health Care, Certification. Available at: http://www.jointcommission.org/. Accessed March 1, 2016.

3. Photographs of Dr. Snodgrass’s certificates and documentation of 44 months of ACGME-accredited postgraduate training- every month denied by the SBRHA. Available at: https://twitter.com/BrettSnodgrass1/status/703386555071639553. Accessed March 1, 2016.

4. Brett Snodgrass, MD v. Missouri State Board of Registration for the Healing Arts – entire case exhibits were not uploaded. 2013 – 2014. Available at https://archive.org/stream/Snodgrass-v-SBRHA/Snodgrass%20v%20SBRHA%202013%202014#page/n0/mode/1up. Also available at: http://bit.ly/BoardReform. Accessed March 1, 2016.

5. Johnson D, Chaudhry H. Medical Licensing and Discipline in America. Lanham, MD: Lexington Books; 2012. Avialable at: http://www.amazon.com/Medical-Licensing-Discipline-America-Federation/dp/0739174398. Accessed March 1, 2016.

6. Snodgrass v. Missouri State Board of Registration for the Healing Arts – Verdict from Honorable Karen A. Winn, Commissioner on October 30, 2014. http://archive.org/details/Snodgrass-v-SBRHA. Accessed March 1, 2016.

7. TMC – Truman Medical Centers. Available at: http://www.trumed.org/. Accessed March 1, 2016.

8. Qiu J, Kulkarni S, Chandrasekhar R, et al. Effect of delayed formalin fixation on estrogen and progesterone receptors in breast cancer: a study of three different clones. Am J Clin Pathol. 2010;134(5):813-819. Available at: http://ajcp.oxfordjournals.org/content/ajcpath/134/5/813.full.pdf. Accessed March 1, 2016.

9. Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28(16):2784-2795. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881855/pdf/zlj2784.pdf. Accessed March 1, 2016.

10. Snodgrass, BT. Breast Cancer Scandal. 2015. Available at: http://drsocial.org/forums/topic/1057/breast-cancer-scandal. Accessed March 1, 2016.

11. Iype EM, Sebastian P, Mathew A, Balagopal PG, Varghese BT, Thomas S. The role of selective neck dissection (I-III) in the treatment of node negative (N0) neck in oral cancer. Oral Oncol. 2008;44(12):1134-1138. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18486527. Accessed March 1, 2016.

12. Annas GJ, Crosby SS. Post-9/11 Torture at CIA “Black Sites” — Physicians and Lawyers Working Together. N Engl J Med. 2015;372(24):2279-2281. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1503428. Accessed March 1, 2016.

13. Arts MBoRftH. Healing Arts News, (Apr. 1, 2015);29(1):1-20. Available at: http://pr.mo.gov/boards/healingarts/newsletters/2015-04-01.pdf Accessed March 1, 2016.

14. Margolis JD. Professionalism, fiduciary duty, and health-related business leadership. JAMA. 2015;313(18):1819-1820. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25965224. Accessed March 1, 2016.

15. Scutchfield FD, Benjamin R. The role of the medical profession in physician discipline. JAMA. 1998;279(23):1915-1916. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18486527. Accessed March 1, 2016.

16. Snodgrass B. Novel insight into the quality of assessment of physicians. Health Care: Current Reviews. 2016;4(155):1-4. Available at: http://www.esciencecentral.org/journals/novel-insight-into-the-quality-of-assessment-of-physicians-2375-4273-1000155.pdf. Accessed March 1, 2016.

Supplementary material – enclosed
I. Reference #16 – regarding the SBRHA’s harassment of the interventional cardiologist Dr. Antoine Adem. See lines 749 and 832-835 above. This describes the SBRHA’s unethical conduct over a period of more than two years related to the interventional cardiologist Dr. Antoine Adem.

II. Manuscript describing the SBRHA’s 5.1 years of unethical conduct related to the psychiatrist Dr. Surendra Chaganti.

III. Unethical letter written on November 20, 2013 by the SBRHA Executive Director Connie Clarkston to Dr. Snodgrass. See lines 92-100, 612-630 for information regarding the unethical nature of the letter. Furthermore, the letter states “please do not hesitate to contact us.” I did contact the SBRHA several times and they refused to provide any additional reason about why I should obtain a multidisciplinary evaluation. Our leaders should be able to articulate why they want someone to go live in a hospital for several days. Connie Clarkston was unable to do that, but she did help enable a pathologist, Dr. KL, to make numerous incompetent evaluations of a resident – such as December 29, 2010 where she wrote “he has not recovered to anyone’s satisfaction.” Dr. KL was asked by Dr. Snodgrass’s attorney on about July 2nd or 3rd 2016 what he was to recover from. Dr. KL had no reply. This is grossly incompetent documentation by Dr. KL, and Frank Meyers was in court when he saw Dr. KL fail to give a reply to the critical question about Dr. Snodgrass’s evaluation written by Dr. KL on 12 29 2010. According to Dr. KL, Dr. Snodgrass was to remain on probation because he has not recovered to anyone’s satisfaction. Instead of addressing the incompetent documentation, Connie Clarkston and Frank Meyers propagated the dishonest and incompetent evaluations and have refused to acknowledge that a physician who is a residency program director should have sufficient clinical insight to know that if she writes that a “resident has not recovered,” then something should be done. Dr. KL did nothing reasonable after 12 29 2010 and instead of addressing Dr. KL’s inability to competently communicate critical information, they apparently instructed Dr. Snodgrass to obtain a multidisciplinary evaluation. Similar to how the SBRHA and Frank Meyers enabled the Dr. KL to lie and then disciplined Dr. Snodgrass at the expense of patient safety, Connie Clarkston made bizarre and harassing efforts towards Dr. Snodgrass at the expense of ensure that Dr. KL could communicate critical information and assessments to those that she manages.

IV. A print-out of the letter that Dr. Snodgrass received where his job at St. Elizabeth’s hospital was rescinded after he informed them – about what Dr. KL informed the Georgia Composite Medical Board – that Dr. Snodgrass was on probation when he was at UMKC. According to Dr. Thomas Nasca, CEO of the ACGME and Dr. Jill Moormeier, Dr. Snodgrass was never on probation at UMKC. In spite of this blatant dishonesty and extensive harm caused by false claims filed with the GCMB, Connie Clarkston refused to address the dishonesty and punished Dr. Snodgrass. This is unfathomable perversion of the role of a Medical Board Executive Director, and Connie Clarkston should, at the very minimum, acknowledge the dishonesty made by Dr. KL multiple time to the Missouri SBRHA. However, Connie Clarkston has actually enabled and empowered Dr. KL to propagate her lies, and this is an egregious violation of basic ethical principles.

lying about breast cancer care
Lying about patient care matters

Comments and Suggestions are Welcome.

What do you think can be done to ensure that physicians in Missouri stop lying?

 

 

Missouri State Board of Healing Arts Ethics Complaint

How to File a Complaint With the Missouri State Board of Healing Arts

FAQ:

How can I file a complaint with my state medical board?

Board of Registration for the Healing Arts

3605 Missouri Boulevard
P.O. Box 4
Jefferson City, MO  65102
573.751.0098 Telephone
573.751.3166 Fax
800.735.2966 TTY
800.735.2466 Voice Relay
healingarts@pr.mo.gov

 

Answer:

Electronically via a PDF, or, in writing.

If you complete the PDF, you can email it to the Board at their above email address. If you choose to send it in writing, you can send it via standard mail to their above address.

It is important to note that the Board’s physical location is different than their mailing address. The address of the Missouri Division of Professional Registration

Address: 3605 Mo Blvd, Jefferson City, MO 65109

 

Leadership in Communication

I went to their office and attended their teleconference in April 2012, but they did not permit me to speak about anything other than their listed topics. This is a problem because I had critical information about patient care that they had repeatedly ignored. One is better off talking to a wall, than trying to communicate or share information with any of the medical board members or their staff. In contrast, the North Carolina Medical Board’s staff has been helpful and professional during my interactions with them. Apparently some state medical boards value other people, and some, such as Missouri, live in a culture of collective narcissism.

Comments and suggestions are welcome,

-Brett Snodgrass, MD

 

 

 

How to File a Complaint With the Missouri State Board of Healing Arts

Frank Meyers, JD, prepares to protect an animal

Connie Clarkston Holds Needle With Drugs for Public Safety

Mr. Meyers and his close companion Ms. Connie Clarkston have a rather twisted idea of what it means to protect others…

 

Frank Meyers giving vaccines with long slender needles
Frank Meyers gives the “animals” their medicine – for the safety of the public. Mr. Meyers said vaccines were necessary for safety. One may wonder whether he is competent to administer “vaccines.”

Time for the “animals” to get their medicine instructs Ms. Clarkston – the executive director of the Board of Registration for the Healing Arts. Unfortunately, Ms. Clarkston does not typically know which medicine is appropriate for patients. She sends his thugs like Mr. Meyers, J.D. to litigate claims of competency. Unfortunately, Mr. Meyers did not know what PubMed is. It is time that state medical boards become clinically competent. We do not need ignorant attorneys like Mr. Meyers being pushed by their nefarious executive director Connie Clarkston to stab good doctors in the back while protecting perjurers.

 

Another example of dishonest medical regulation is where Connie Clarkston and her thug investigators tried to frame the psychiatrist Surendra Chaganti, M.D., for the death of a patient.

The nurse gave the patient seven medications intended for a seizure patient to Dr. Chaganti’s dialysis patient.

Take your medicine
Connie Clarkston is ready to give Dr. Surendra Chaganti his medicine.
Vaccine time
The Missouri Board of the Healing Arts gave Dr. Antoine Adem his medicine.

It will be up to the future generation of healthcare leaders to teach state medical boards to obey the American Medical Association code of ethics.

Frank Meyers, JD, prepares to protect an animal

Did State Medical Boards Cause Medical Error to Become the Third Leading Cause of Death in America?

culture of silence fostered by state medical boards
Why is medical error the third leading cause of death in America?

A recent article published in The British Medical Journal asserts that medical error is the third leading cause of death in the United States of America. 

Many healthcare providers have commented on a summary of the article at medical error the third leading cause of death.

 

 

To measure the present value of the healthcare system, we would need to know the death rate from no medical care.

Perhaps occasional deviation from the standard of care is the “standard of care.”

Dr. Stephen Adcock said,

Unfortunately, there is no explanation of how cause of death is determined to be due to medical error. A description I read years ago employed fallacious methodology, with totally unwarranted extrapolation which clearly overestimated the prevelance. I advise all practicing physicians to divide the purported number of “deaths due to medical error” by the number of hospitals in the U.S. and ask themselves how that compares to the number of deaths due to medical

error they have witnessed in their own hospital. I predict a major disconnect!

The problem is real and needs ACCURATE analysis; exaggeration risks triggering a “Peter and the wolf” reaction which benefits no one. We must be honest with ourselves and our patients, but sloppy, inaccurate information breeds inappropriate distrust which may cause patients to avoid seeking necessary medical care and suffering the consequences.

 

Dr. michael cobble said,

“Bankers leading cause of money loss in America.” This would have been just as sensational for headline news and just as inaccurate.

 

Dr. Jose’ Carlo said,

…Why doesn’t Pearson testing industry take the lead to correct the mistaken notion of [their] intellectual excellence for  a doctor to practice and not have us blame us for shortcomings ?  …

Dr. John Gray said,

As health care becomes more complex, more computerized, more different caregivers, and more medications etc. for each patient, the risk of error increases greatly.  It is often easier to harm a patient than to help him/her.  We physicians want to help but frequently overestimate the benefit of our treatment/test/care of our patient and greatly underestimate the potential harm. This study should remind us to be better informed and more thoughtful.

 

Dr. sudhakar kamat said,

As someone who has worked in UK,USA and India for over 60 years,I would like to state the trouble starts with lab reports where some junior reports without getting to know clinical relevance;Doc doing cursory exam and hardly any discussion;In following progress,little attempt to change/or modify the diagnosis.Despite vague       error in progress is ignored-Ego,poor discussion come in watErrors mount and in diagnosis,and death certificate cover up occurs;We must have joint review on many complex cases and agree to learn and do better clinical review;only a few come to light medico legally

Dr. Zheng Zhou said,

The conclusion taken out of context is misleading and raising concerns and tensions from both treating physician and patients’ family side.  I can also quote: “the second leading cause of death on the battlefield is cross-fire” — I would urgent caution in disseminating the conclusion, not just to make the headline.  As physicians, all what we do is: “intention to cure”.

 

Dr. Eugen Sofronov said,

@Dr. Zheng Zhou yes, the intention is to cure, but a lot of deaths are attributed to side effects from the medication or intervention itself with the right indications and doses.

best way to prevent iatrogenic deaths is not to end up in doctor’s hands

Detailed reports of fraud from the Texas Medical Board (TMB) are explored in a video by Dr. Brett Snodgrass, an author of an article on unethical conduct by another state medical board.

Dr. Mark Williams said,

Perfection is something to strive for but unlikely. The definition of medical error is the question. I think that if “medical errors” are the third largest cause of mortality there is a liberal use of the phrase. I would suspect there are these “errors” in many of the successful treatments of patients. Maybe we should therefore have a similar conclusion. (I.E. Medical errors are the third most common cure…)

 

Dr. Donald K King said,

Years of productive life lost, as CDC used to tabulate, would be more meaningful than crude or “translated” death rates.

Tamara Mullins said,

Jeff Mullins, MRC wrote:

The authors admit the article came from discussions about the “paucity of funding” but then declared they had no competing interests. I read this to mean there only interest was to gain more funding.

These John’s Hopkins professors attribute a Causal relationship where the four studies reviewed were not of the requisite standard to determine this level of relationship.

The authors suggest “death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.” Therefore, how can we know if medical care “caused” the death, when the authors clearly suggest we don’t yet have the data to determine if medical care even contributed to the death?

Better tracking methods seems reasonable and prudent, but until such time we simply don’t have the data to support the conclusions drawn. Frustrations over lack of funding is not an excuse to violate basic research principles.

 

Dr. LEROI PRICE said,

“They add that most errors aren’t caused by bad doctors but by systemic failures and should ‘not be addressed with punishment or legal action” The implication is that doctors are bad. I resent the implication. Further, this study makes no sense. I kill more people than disease? Well, I am not a professor so I must be incompetent. What use is this study except for these guys to get their name in print? This sounds like a crisis. Why are we not doing something? As a responsible physician I would very much want to be fixing this problem. This sounds like “political correctness”. It walks like a duck, it quacks like a duck.

 

Dr. Eugen Sofronov said,

@Dr. LEROI PRICE iatrogenic deaths include ones from the expected side effects of drugs and intervention (correctly prescribed, dosed, indicated and performed) and hospital acquired infections are also iatrogenic.

Dr. LEONARD KABONGO said,

This shows how the issue of patient safety and quality of care is at stake.This is not only doctors errors but system failures to detect errors and correct them.The US need to redesign its healthcare system by introducing checks,not by routine but a multidisciplinary approach and shared responsibility.Medicine isn’t easy..What we know today was a mystery yesterday and what we don’t know will kill our patients until we know…but we will never have a perfect knowledge during our existence…

 

Dr. RICHARD KONES said,

Yes there are errors, and physicians contribute.  However, the acceleration of errors in the past years, since the major changes that have occurred are in the healthcare system and constrictive micromanagement, point more to these recent changes.  In addition, the ill-conceived yet increasingly popular movement to self-diagnosis and self-treatment, has also contributed. Third,  the powers that be prefer to again point to physicians as responsible for all poor outcomes, also not the case. [This attitude is the basis for much of the new “reward” system that took the place of “meaningful use”–assuming all risk is under MD control, when in fact very little is.] 80% of deadly disease is chronic and due to abysmal health habits. Control of the food supply and of the physical environment to promote healthy habits is a government issue. There is no better illustration than the policy of subsidizing unhealthy foods and misdirected policies. Fourth, punishing physicians for poor adherence to prescribed medication and recommendations is questionable.  Last, the flaws in this study and assumptions have been discussed above.

 

Dr. jessada suwannasin said,

this  topics   is   very     good   for   stimulation  of    safe  medical    practice   because   medicolegal  problem  is  the  leading   update  interest  topic   in  Thailand  .

 

Dr. Adam Pawinski said,

Irresponsible and provocative statement. The conclusion, that a hospital administration should make more effort to follow such accusation is even more dangerous. Medical error happens. The most important REASON of it as far as I expect never be lightened. The first and most often seen in my practice reason is overload of work, lack of time and that what is main threat, administrative burden of work which hospital office more and more embark medical professionals in exchange for patients care. They may not be a judge in solving their own errors. Our medical doctors and patients organisations must be involved.

 

Dr. Thomas Guastavino said,

The line that caught my eye:” ….an extra field to determine whether a PREVENTABLE COMPLICATION contributed to the patients death” Just like the original “To Err is Human”, we are failing to properly distinquish between an “error” and a “complication”. Couple this with the implementation of Accountable Care reimbursements models and the avoidance of complex, difficult, high-risk or non-cooperative patients will explode.

 

Dr. robert johnson said,

If the medical error mortality data isn’t tracked or published how could you possibly come to the articles conclusion? Does the author have access to secret data? Is this a meta analysis of studies that extrapolate data from interviews with health care workers?

Dr. Rabindra Nath Misra said,

To err is human. The doctor may have taken all precautions in a procedure but due to error a fatality has occur ed. Can he/ she or the institute survive a legal action or damage considering the present atmosphere of litigation?

 

Dr. Mohamad Aboras said,

This report makes american doctors very honest and trustful. Unlike doctors in other countries. I would look at that with big respect. This is the medical practice as it should be.

 

Dr. jayasundar kondaveti said,

It is alarming to know that human error is the third leading cause of death in USA. If in an advanced country like USA , so many people die of human error , what is the fate and death rate of other countries including less developed countries. We can decrease the mortality rate by compulsory updates to all medical fraternity in various ways like conducting CMEs , seminars and exams if necessary for all the doctors at frequent intervals. Doctors degrees can be cancelled by appropriate authorities if gross negligence is proved beyond doubt and causing death of the patient. Doctors should maintain ethics and avoid unnecessary surgeries for monetary gains and to maintain hospital targets.

Dr. silvia garcia said,

Dr. Makary, a surgical oncologist, has published an article in the British Medical Journal where the sensationalized clickbait headline is “Medical Errors account for the third leading cause of deaths in the US”. There it is, making the rounds on NPR, nightly news talk shows, etc. Patients and politicians are freaking out on those crazy doctors killing us. Read the actual article here.

Just step back for a moment. This man is a researcher whose niche is analyzing medical errors. He’s a surgeon specializing in cancer. He wrote the book on implementing checklists in the operating room, like pilots have pre-flight, where the surgical team takes stock of where they are, who they are working on, and why. This is now why whenever you enter the health realm, you’re asked 50 times by 50 personnel who you are and why you’re there, and patients harrumph back and give bad reviews on HealthGrades on how they were continually asked who they were.

Dr. Makary notably ends his paper bemoaning that there aren’t ways to measure medical errors because WE DON”T HAVE THE ICD-10 CODE FOR IT. That’s right, we need ANOTHER code for this and every hospital, death certificate, etc has to have a space where the code for what the medical error was that caused the patient death.  He tugs at heartstrings, citing I assume from his world, a case of a young woman who was a transplant recipient (soooo, wouldn’t she be dead already if not for the transplant?) whose death eventually came from an error in the judgement of a procedure she received when readmitted to the hospital because she fell ill again.

THEN he bemoans the lack of funding for medical errors, his niche area, and hence his dearth of grant money.

  1. Dr. Surgical Oncologist, why aren’t you writing about surgical oncology? Not operating anymore, because no patients. So he sat around chewing the fat with a friend, and in the discussion they figured the way out for them was to analyze the analysis of the analysis (spearheaded by the oft quoted Institute of Medicine 1999 Medical Errors paper) and in so doing, extrapolated their findings to the whole population of hospitalized/sick patients.

I’ve had enough of being demonized and it being assumed that doctors are making so many errors all the time that it’s a wonder anybody is alive.

No question that medical errors happen. No question that there’s been a slew of soul searching and action from all of these papers, editorials, CME, safety committees–“pause and stop and think and remember where you are”.  Use your checklist.

All in the 7 minutes the doctor is allotted to attend to Mrs. Smith.  Do it fast AND to perfection, every minute, every day. We are already doing it as fast and as perfect as we can. We have to comply with MACRA, MIPS, MU, EHR mandates, 5-figure malpractice insurance premiums, our corporate bosses telling us speed it up or we’re fired, denial of payment for actually rendering a service to the patient, calling them back, imploring them to take their meds, listening and comforting when they’re in pain and infected and not doing too well. Overdose.Retire. Walk away. Suicide. We can’t do it anymore.

How about the EHR errors? How about the government errors? How about the pharmacy errors? They all get lumped and dumped into medical errors. See what they did here. Medical is the root cause of all evil, and lets’ get them out of the way.

I’m not sure who is actually going to be left to do the transplant. I hope when my time comes for real serious medical care, there’s someone left who can fix my troubles, not MACRA, MIPS, MU, checklist charlie.

 

Dr. Deborah Proctor said,

@Dr. silvia garcia I’m sorry Dr Garcia;  I’m afraid it’s already too late!  The system is too far gone, run by administrators and regulators rather than physicians.

Condescending medical regulator
Condescending state medical board member jumps to conclusions about patient care without investigating the cause of death.

You’re only hope for concerned, skilled, compassionate care lies with our ability to change the system.  Hold the corporate and federal regulators liable for malpractice committed because of their policies.  Why are physicians paying for malpractice insurance when it’s the HMO’s, feds and regulators who are dictating practices.  How many EHR indicate a physical exam was done when the patient wasn’t touched?  Why should physicians pay when they’re essentially forced into malpractice?   Who can do an H&P, ddx, order tests and prescribe in 15 minutes?  No one, but the EHR indicates they did.  Nothing will change until the right people are held accountable but the big question remains:  how do physicians and providers fight back?

Dr. Frederick Beck said,

@Dr. silvia garcia

Dr. Garcia,

Your 7 minute paragraph sums it up perfectly.  Patients are often very complicated, on multiple medications, have a myriad of active issues and there is just not enough time to explore everything meticulously and comprehensively while we also function as a data entry clerk logging it all into the system.

It’s laughable.

Jan Fischer said,

This is a problem of the systematic dysfunction of our healthcare system. With the introduction of EMRs, Obamacare’s influx of more patients, and increase in populations of unhealthy patient lifestyles the healthcare system expects fewer workers to take care of more patients in less time. The system needs to build in safety guards for the safety of patients and staff. We need to designated staff who solely focus on one area of mortality risk factors such as discharge summaries, telemedicine for following up on care of at risk patients, multimodal pain treatments when narcotics can’t be prescribed, post-op wound and surgical complications Etc. Whatever your possible mortality factors are for your healthcare setting highly qualified staff should be providing a safety net for vulnerable patient populations. Medscape could provide an open forum for developing ideas and results addressing this issue.

 

Dr. Randolph Whipps said,

I have been in practice at multiple hospitals over thirty years.  I have been critical of my peers who over test and over treat.  I still have a very hard time believing that error is the third leading cause of death.  If that is what they are seeing at Hopkins I would suggest many other places to get your care.

 

Dr. robin mcgoey said,

Working hard to increase the consent rate for medical / hospital autopsies would go a long way to enable us to standardly examine whether error contributed to death. Also, reinstating a requirement for a % hospital autopsy rate, similar to that once stated by the JC, would also help. As a medical community, we need to push for using the medical autopsy as the gold standard for driving QI and for examining fatal error.

 

Dr. LEONARD KABONGO said,

@Dr. robin mcgoey What about errors in autopsies?

Dr. robin mcgoey said,

@Dr. LEONARD KABONGO @Dr. robin mcgoey

I fully understand that concern, Dr. Kabongo.  I believe the most accurate autopsy is the one attended by representatives from the treatment team- with the antemortem labs, physical exam, imaging, cc and HPI all reviewed and available to discuss.  All gross findings and therapeutic devices (lines, trach, ETT) are explored together in an interprofessional and multidisciplinary approach with an eye towards QI/PS. We always learn the most in the autopsy suite when the silos of medicine are broken down and the clinical care givers and autopsy pathologists are permitted to communicate and discuss findings and diagnostic considerations.  In this way, I think we maximize the potential of answering the question here: did error contribute to death or not? But, again – I do understand your concern, particularly if the autopsy is performed ‘in a vacuum’.

 

Barbara Schroeder said,

@Dr. robin mcgoey  I totally agree with the autopsy driving quality assurance .  It would also help to ease doctor-family relationship.  Basically it would be transparency.  To err is human, but perhaps we would also find out why certain procedures are not effective or safe for certain patients.  My mother passed away 7/2/2014 from toxicity due to fluorouracil.  We had to fight tooth and nail to get  an autopsy performed.  You would have thought we were robbing the hospital.  They did not want us to have the autopsy.  What were they afraid of?  We only wanted to determine if she was DPD deficient, we were not looking for wrong doing on the part of the doctor (although she should have done an low dose trial first, but that is another issue).

With your role as a pathologist, you have a unique vantage point.  I hope you pursue your statement above to make medical autopsy a gold standard.  Thank you. karenemerritt@msn.com

Dr. Brett Snodgrass2 minutes ago

@Dr. robin mcgoey Also, we need more than pathologists determining the cause of death. They diagnose opioid death by a lab value. Perhaps never prescribing medicines permits many pathologists to forget the altered pharmacokinetic and pharmacodynamic parameters in long-term users of a drug.

Amanda Friend1 day ago

Maybe more support for nurses; Physicians run orders past Charge Nurse, ask for opinions and feedback, and LISTEN to the nurse’s observations and past experiences. A physician who incorporates all of these factors toward pt tx will be more respected and taken seriously. We’re all humans treating other humans.

I’m *only* an LPN, but often I’m a better resource etc than some BSNs, and I won’t let a physician leave without reviewing an order if it’s especially confusing/complicated. We’re all terrified (physicians, nurses, etc) of committing med errors, and we know that bullshit rank and hierarchy doesn’t do anyone any good. There will always be med errors, but there have to be ways to prevent at least some of them.

I committed a HUGE, honest mistake med error the other week, so this has been on my mind big time.

 

Dr. Lovel Giunio1 day ago

And now something completely different

Humans are mortal, or as National Institute for Immortality declared recently in a landmark statement, we are all going to die, just like a famous parrot. We would all like to live longer, and to live a quality life till the end.

Sadly, this natural tendency translates into strategy of treatment that uses in the last three months of her/his life about 2/3 of all the health care resources that a human being that happens to be US citizen is going to use in the lifetime.

An American lives in the U.S. but dies in the hospital. And spends a fortune postponing death for a few months. And dies of medical error trying not to die from the disease.

This is an inevitable strategy if you are willing to fight to the end, even when the chances are slim, or nonexistent.

A strategy that is spreading and prevailing through all developed world, in Europe, Asia  Normalcy is fighting to the end,and that means, alas, dying in the hospital, with the help of a physician.

If old and sick were dying in hospices, or at home, we would not be calling their deaths medical errors.

The article over-streches one particular, provocative point of view, but provocation remains inside the borders of scientific reasoning and argumentation,

It will probably cause some ripples in public perception of medical errors, and hopefully some more funding.

It directs attention to a part of the problem that really needs attention, but fails to address the root cause of the problem of medical errors.

Medical errors that are really preventable, cannot be approached in this manner, unless US radically changes medical liability, malpractice, tort  rules and laws.

 

stacey whitaker1 day ago

But let a Nurse give 325mg of aspirin instead of 81mg because the order didn’t get changed in the new MAR and she/he could lose their job, and license is scared forever.

 

Amanda Friend1 day ago

Unfortunate truth. Totally.

-A.F. LPN

Dr. miro sevic1 day ago

IT SEEMS THAT AN ANOTHER IRESPONSABLE  ARTICLE IS GOING TO CREATE MORE PANIC AND MISTURST IN MEDICAL PROFESSION. THERE ARE NO DATA, MERE SUPPOSITIONS. EXTRAPOLATIONS OF EXTRAPOLATIONS OF EXTRAPOLATIONS.

BUT ONCE WHEN YOU LAUNCH THE NUMBER OF 200.000 DEATH IT WILL BE IMPOSSIBLE TO CANCEL FROM PUBLIC OPINION.

THE THEME OF MEDICAL ERROR SHOULD BE ADRESSED WITH A PROPER METHODOLOGY ( THAT CAN PROVE THE CAUSAL REALTIONSHIP AND AVOIDABILITY)  OF PRESUMED ERRORS WITH DEATH EVENTS.

REGARDS

 

Dr. Mark Drapek1 day ago

@Dr. miro sevic Those capital letters are killing me!

 

Dr. eugene saltzberg said,

@Dr. miro sevic AMEN!!

Rory Barnes1 day ago

The question should also be asked: How many lives out of the 35M admissions were saved?

Any datum is only as valuable as it an be compared with another datum

 

Dr. Deborah Proctor1 day ago

Geez; finally a study published that wasn’t  designed to show doctor driven opiate deaths as a leading cause of death in the US. (or is it buried in the details).  I’m with the others who’ve contributed here who would like to see the data on what deaths were attributed to.  Do they dare address patient/provider ratio, hours on the job, demographics, etc?  When are we going to publish studies on the impact of regulatory factors on patient care, morbidity and mortality. And for that matter, what happend to the old M&M conferences from which so much could be learned?  Patients are living longer, many with very complex issues, on a myriad of medications, with constant pressures to reduce time spent with them.  Hospitals and insurers want  less antibiotics, less opiates, less tests, shorter and less hospitalizations, more outpatient surgery and less access to skilled nursing care.  We’re encouraged to send patients home to unskilled caregivers and friends then some brilliant researchers have an epiphany leading to the discovery that medical errors are the 3rd leading cause of death in the US?   Would deaths from cancer and CVD be any less if we were allowed to practice medicine as taught and not suffering from burnout, eventually dreading the thought of seeing another patient?  Then there are the hospitalist who I read are responsible for as many as 200 patients a day.  If true, that’s a recipe for disaster.  The times they are a changing.  People just aren’t like cars who do well being addressed in an “assembly line” fashion with greatest emphasis on clerical work. Medical error isn’t the 3rd leading cause of death, it’s imperfection; the inability to be perfect in the current climate and under current demands of America’s new health care system.  I really do like President Obama and feel he tried to do the right thing, but he had no idea of how badly his admirable efforts could backfire.  Both patients and physicians are worse off and I have only one idea of how to get back on track with regards to education but it would be useless as long as insurers and government continue to escalate their dictation on medical protocol

 

Dr. Renjit Sundharadas1 day ago

Would be interesting to do a study showing how much morbidity or mortality can be explained by the patients themselves.  That would be a real interesting statistic.  How much bad behaviour leads to CV disease and Cancer.  How many die from guns and drugs.  You’ll find out real quick that the main source of patient mortality is from the decisions and actions patients take that result in their ultimate demise.

The problem with this type of study will be that the craziest of patients will then be more suspect of medical care and be even more difficult to deal with when the real reality is the greatest danger to patients is the decisions they make.  Since no one wants to blame themselves and the health care system is all about not blaming or holding patients accountable the reality of the situation is inadvertently suppressed.

 

Dr. francis applegate1 day ago

look back about 10 years and you will find the CDC was saying the ESTIMATED death rate was more from S.  enter-itidis  assoc with eggs than there were deaths from  all causes of  food  poisoning ESTIMATED by the USDA!  Later in an editorial in our local newspaper taken to task the CDC then told the caller there were 450 deaths a year but they surmised the death certificates did not  truly reflect  the actual causes of death.   It is clear to me that  they have a dislike for allopathic physicians.

Dr. S Johnson1 day ago

Now let me get this straight.  Our progressive liberal government has spent how many truck loads of money (which we had to borrow) to “FIX” a so called broken system????  So, how much more money is going to be spent to fix the fixed problem.  Oh let me guess Liberals can never spend enough.  Its pass time for Doctors to take back the healthcare system.

 

Amanda Friend1 day ago

and the Nurses…?

Work with, you’ll be thankful for what we know and can do

 

Michele Morin said,

@Dr. S Johnson… Don’t you hate it when someone drags a completely irrelevant political point into an intellectual discussion? Especially when there is no connection to a great article. I do. Oh yeah *past*… not passed.

 

c j1 day ago

I’m posting again cuz I believe these real hospital and physician mistakes show how very difficult they are to expose and the damage that can be avoided if transparency rules. I think it has been list in this very active comment thread.

c j  said,

“Obviousely, this article has hit a nerve. While always appeciating candor, I find some of the clinician posts here disturbing. Coming from the Northeast (and no, JH is the Mid-Atlantic so please do not confuse the two areas), I don’t need a study to know what goes on.

When process fails, it needs to be identified & investigated so it doesn’t happen again. Otherwise, it becomes an issue of what one can get away with. And the end-goal in that game is not what good medicine is about.

Unfortunately we have gotten ourselves to a place where there are not enough checks & balances. And sorry to say but the nature of healthcare delivery today does not elect or culture personalities that naturally lead the system in tandem with self correction on an individual or institutional scale….until forced to. That’s not a good way to function.

Personally, I think the record/communication issues we have today….which DOES contribute to errors… is a result of competing healthcare entities. Yes, they are competing for the patient’s ‘business’ …which is their health issue. So much energy and money is wasted through this competition. When the system has such challenges, quality of care / outcomes diminishes and mistakes increase.

No one is licensed or accredited to damage patients. So why not self-monitor and fix the issue? If there were no mistakes, it wouldn’t be a problem for anyone.

I remember late ’94 & early in ’95, we had a problem in the Northeast. Before it was publicized, I had spoken with someone at that hospital and came home scratching my head. I had a very bad feeling about how things are being done there and actually expressed that to a few people. Soon aftet, we all learned that a person had died due to the wrongful administration of chemotherapy agents. There was no self reflection that was going to happen in that hospital (on its own) and it would have functioned the same way had it not happen to a married couple, a research scientist and a journalist. Another patient died.The hospital was forced to close down all beds. And the ‘fixing’ began. Only then, when the cat was out of the bag, did they utilize their full capacity to change and do better. But it was SOLELY because the error had been made public. See:

https://psnet.ahrq.gov/perspectives/perspective/3/organizational-change-in-the-face-of-highly-public-errorsi-the-dana-farber-cancer-institute-experience

More recently in Boston, a doctor went on a campaign to make changes in the training of GYN surgeons in reaction to the outcome his wife, also a clinician, who underwent a myomectomy only to be dx’d with late stage cancer soon after with her prognosis GREATLY reduced due to the technique CHOSEN bythe surgeon. See:

http://www.bostonmagazine.com/health/article/2016/03/20/amy-reed-morcellation/

Please note the all out resistence of the culture to change and exogenous pressures that have forced it. This is in the same city, nearly the same hospital, as the one in the first story above.

(Note: I had the same operation at another teaching hospital in ’98. The surgeon explained the morcellation would be utilized but surgical technique would prevent contamination for the most part. So Hooman is correct in insisting that more advanced surgical technique should have been AND COULD be utilized.)

I think the resistance in the comments here is a microcosm of a culture that can make mistakes but resist the hard organizational and individual work required to acknowledge them and make changes goimg forward.

I hope this gives pause to reflect.”

 

Dr. GEORGE RITTER1 day ago

There  are  numerous efforts  to clarify  this   problem. If  a  patient  falls  because  the  aide failed  to bring  the  bed pan, whose  error  is  it?  If   a visitor visits  a patient  and  gives  him  pneumonia,  is this an error? If on  a  “hand off”   a patient  s  not treated  properly  for lack of communication  Is this an error? I dare say, if we  look  hard  enough , we  will find  an error in almost EVERY   hospital admission.

 

Andrea Cahill1 day ago

You seem to have missed systemic error in your comparisons.

 

Dr. Ted Dodenhoff1 day ago

I would have to see more specific data to go along with the title of this piece. Are you telling me that after Heart Disease and Cancer #3 has to include all other causes, of which Medical Error is at the top of this massive category. What about , infectious disease, drug addiction , malnutrition , accidents , trauma , homicide, etc.

Scott Manhart1 day ago

The devil is in the details of what we call a Medical error.  An error is on an error if there exists adequate information available to choose otherwise.  For example Anaphylaxis is only a error if there is a know history that is missed ignored.  My understanding is all allergic reactions to pharmaceuticals count as medical errors even though the vast majority can not be avoided as they are the initial event.  there are many similar problem is this data set as well.  This of course does not matter to the health admin types who are obsessed with characterizing US health care system as a horrible abomination in need of federal makeover.

 

Dustin Tatman1 day ago

Perfectly healthy people aren’t dying. Who gets credit if a CAD patient dies from a questionable medical decision? Does it go in the heart disease category or the medical error category?

Should we score it like hockey where 2 players get credit for an assist?

 

Dr. DAVID POWERS1 day ago

Absolute Malarky!

I do not believe that Doctors KILL 10% of the people that die each year in the US.  It may be that a glitch- a systems failure, a medical error, occurred in association with a patient’s death,  but the underlying illness- CAD, Obesity, HTN, CA, smoking induced pulmonary or vascular disease, a hip fracture, ect, etc, is what kills people.  If doctors are killing  that many people, forget about accidents, guns, illicit use of drugs- just get rid of doctors and you’d save lives and untold dollars.

 

Dustin Tatman1 day ago

Medical Procedures should be like Olympic diving where they assign a “degree of difficulty” to each attempt. There’s a big difference between attempting something difficult on a risky patient where something could go wrong, and making a bone-headed belly flop and amputating the wrong leg.

 

Mary Hyatt1 day ago

After reading a few of the other comments, I am adding another perspective. Our hospitals have moved from  8 hour shifts to 12 hours shifts, despite studies that indicate the impact upon errors. I was a hospital staff nurse for 37 years. I did not wish to work 12 hours shifts but this past year I no longer had that option. I found that working a 12 hour shift taxed by memory, focus, & ability to concentrate, as well as increased the arthritic pain in my feet & knees.  Despite the fact that I truly enjoy nursing, I do not wish to work under those circumstances. I have retired & moved on.

 

Dr. Gordon Banks1 day ago

It is also important to know whether this was someone who was killed by an error when in for a simple procedure such as an appendectomy or was someone on death’s door who was killed a few days earlier than they would have succumbed to their disease.  I think it makes a difference.  The latter is much more vulnerable, being on the edge anyhow.

 

Andrea Cahill1 day ago

A bit insensitive me thinks  …

Kristin Carr1 day ago

If the treating physician is the one signing the death certificate, the chances of admitting to error are slim to none.

 

Dr. C Cummings said,

Some what jaded assessment…. All doctors are without integrity and the ability to self assess. I find most of my colleagues are harder on themselves when confronted with a complication. Another hit piece on physicians

 

Dr. Elwin Dunn1 day ago

I find an article like this very disturbing.  They use data from one time period (2000 to 2008) and do not disclose what they considered a medical error as a cause of death, then they extrapolate from a different time period (2013) to state that their percentage of deaths was 9.5%.  .

Finally, they assume from truly questionable data, that that % of deaths in the US equals that many deaths due to medical error.

I am a retired surgeon, and can only base my opinion on the lifetime of my practice.  My memory of practice errors comes nowhere near what is suggested here.

Elwin Dunn, MD, FACS

 

Dustin Tatman1 day ago

@Dr. Elwin Dunn  There’s definitely some soft numbers in the author’s estimates.

 

Dr. B W said,

Agree

I read the article.

Id say it is full of preventable errors.

 

Dr. Anurag Tewari1 day ago

Erroneous intravenous drug administration has a high probability of causing substantial financial consequences along with patient morbidity or mortality. Anesthesiologists and hospital administrators need to be cognizant of the problem. National and international anesthesiology bodies should be involved with the medical device manufacturing industry to alleviate this long-standing enigma. At the University of Iowa, we created an innovation VEINROM that will ameliorate the errors substantially.

http://joacp.org/article.asp?issn=0970-9185;year=2014;volume=30;issue=2;spage=263;epage=266;aulast=Tewari

Dr. Javier Cabrera1 day ago

Another cause of death in patients  are surgical problems due to complications in total hip and knee prosthesis replacements.

For decades problems due to device failures in hips and knees prosthesis have been reported worldwide.

By replacing bone by  an stiff metallic prosthesis inserted into a continually changin  living bone , we trigger a series of problems,  like metallic particles infiltrating in tissues and loosening of the  device. Revision surgery is the solution in many cases,  but in other  cases  the problem persist or gets worse,  debilitating patients health,  especially in the elderly . I wonder how many deaths  are due to this kind of complications, including infections.

We should prevent the destruction of the joint by resurfacing  with biomaterials, stem cells therapies, etc., initial lesions in the articular cartilage that generally are undiagnosed or left behid with palliative treatments,  until the joint is destroyed (osteoarthritis )and in need of a joint prosthesis. This type of surgery is  very expensive,  aggressive and not  free from severe complications.

 

Ruth Phinney1 day ago

1) The fuzziness of the numbers is acknowledged, but the conclusion of the actual article is that no matter how fuzzy, medical error is much larger than previously recognized.

2) “Medical error” includes more error than physician error. These results do not “point a finger” at physicians.

3) Error rates even approaching this large (even at the rates previously published) indicate systems problems, so physician defensiveness is not warranted, rather root cause analysis (look it up if you are not familiar with the term) to determine what can be done on a systems basis to reduce the propensity for error is what is called for.

4) The major thrust of the article is that an accurate method for finding the true rate of medical errors is needed. The assumption appears to be that addressing found errors (via root cause analysis) would be a foregone conclusion.

One would like to think that any results indicating medical error problems would generate a physician drive to investigate, confirm or deny the findings, and problem-solve any confirmed issues. It is very disappointing to see the posts here, which tend to be a that-must-be-wrong response, without willingness to address a potentially serious problem.

 

Donna Rossa1 day ago

One of the main issues observed in hospital surveys is employees not being educated on policy and procedure changes in administration of medications. Also the blame is often placed on one person instead of a system breakdown.

 

Dr. Carlos Sottomayor said,

It´s a fatal error consider this statement. Today 98% of the deaths in developed country ocurred in the context of chronic disease, under medical chronic vigilance and medication and the terminal event habitualy ocur at a hospital like institution and the link of causality is very dificult to prove but is always an inevitable event. With the cumulative chronic disease and the age of the patients is possible to say that the leading cause os death is the beds of the hospital or the air or the water or the food

Dr. ANWARUL ANAM KIBRIA said,

Interesting.

Dr. gary dufresne said,

Would love to see the methodology used in this retrospective review that was published as research. This is a great example of pointing fingers at physicians who are constantly asked to do more with less. Work harder, faster, meet meaningless metrics set by some administrator, see your patient in the waiting room, do a procedural sedation in X-ray, continue to except patients and stack them in the hallway despite there are no available beds in the hospital.

My Hospitalist colleagues have a 200::1 pt to doctor ratio. Is that humanly possible.

No one else will say it but I will. I only bring it up because it highlights our doctor shortage. If there are 250,000 deaths do to medical errors every year, how many of these lethal a errors are committed by physicians that were not trained in the United States? If I extrapolate the same way they did in this review article, the answer is approx one third or 80,000. Thank god we are poaching the best and bright from other countries because the problem would be much worse.

Stop reporting on this review article in this way. We do critical reviews of all research published, why not scrutinize a “research” article claims that physicians throughout the USA are conspiring to kill a quarter of a million patients per year.

 

Dr. K BOSE said,

It is like when your son is arrested for dope or rape, or your 16 year old daughter  misses a period. Difficult to admit’

As a physician who has suffered from poor( mal) practice some, near killing me ,let us admit errors, mistakes and carelessness do occur. The percentage we will never know. Not even ten % of errors are reported sued and even then not 10% win for the patients.

AS an intern I suffered a serious crush injury to my knee . A ” famous prof. of a famous Med College in Chicago, let me in a cast for 2 weeks,and when he decided to operate, my knee was infected, and I still cannot bend.

2.As a resident I suffered bloody diahorrea, an Asst. professor did a rectal biopsy and I blood to near death.

3.My unbenfdable knee was replaced by prosthesis 35 years later. In the recovery room I blood to near death, by the time the “watch full recovery nurse” noted I had no pulse or BP. On the OR table my heart stopped.

There are many more mistakes, I have lived through.

When inexperienced residents  are allowed to be in charge..” Oh I had not slept in 23 hours” things go wrong.

In many institutions, College Hospitals instead of giving best care, people get bad care since the highly paid staff goes home at 5 p.m. and cannot be reached on week ends. In CA, all Medical calls, get an advice to go to the Busy ER with poorly trained over worked staff. to wait hours!
THE ER residency program is thriving, as they feel like it is the easy way to richness and not much responsibility, book keeping or billing. God save US

Yes The DEmocrats and Obama, and next year Hillary did it.Ha Ha!!

 

Dr. David Magee said,

How about errors of omission? When the CT or MRI or necessary drugs or necessary procedures won’t get paid for and the patient suffers or dies? Let me guess….Doctors are to blame!!!!!!! I just saw one of the researchers on the news and he was fishing for funding- again call me skeptical.

 

mary bush said,

one simple fix-stop making physicians see 50-60 patients a day.  a good friend of mine who is leaving for a smaller hospital said that he can remember 20 pts and their names, 25 patients and he knows room numbers, 30+, he can’t remember anything.

 

JK Lenehan said,

Dealing with both errors and complications is an issue that patients frequently face, even if doctors refuse to admit it. Why do so many women die from heart attacks ie sent home from the ED with a dose of Prilosec or an anti anxiety medication for chest pain?

https://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_472728.pdf

http://www.drjkoch.org/Medical Soc/5381 Spring 2016/Other Ep Files/Official statement.pdf

Why are women’s symptoms and pain treated differently than men’s ie dismissed versus treated aggressively?

http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1144&context=fac_pubs

Right now, patients are being punished for errors and lawyers seem to be the only recourse.

All patients and all doctors would prefer to get it right. This isn’t about tort reform, this is about attitude. An error might get an HCP a reprimand but that error may cost a patient the expense of fixing the error (be it extra bed rest and time off work all the way to spend years trying to find another doctor willing to fix the problem caused by the first doctor). Patients really want their concerns to be heard and treated appropriately which means believing and genuinely investigating reports of pain or other symptoms versus ordering CYA tests and then hoping the patient will go away. This leads patients to believe they are also supposed to ignore symptoms and then as many noted in the comments…patients who delay treatment until issues are more serious then have an increased risk of complications or…death.

  1. Prevention at home (i.e. Diabetes control, hand washing etc)
  2. Be willing to treat the patient for symptoms until they clearly are better versus feel better. Tell them to go in sooner rather than later and then sincerely back them up both in the ED and at the GP levels.

I’m glad they published this article.

 

Arlene Dorrough said,

@JK Lenehan Thank you for your thoughtful reply.

 

Dr. Justin Hamlin said,

The Democrat Party is still the #1 cause.

 

Arlene Dorrough said,

@Dr. Justin Hamlin Please.

 

c j said,

@JH: Sorry but you need to do your research to understand what has happened to healthcare. Actually, it is Republicans who first introduced the basics of what we are seeing today (Surprise!!!) But one must have a longer political attention span to understand this. Bottom line: it was a political hot potato that was let go WAY too. Now system and the tools to maintain it must be built/rebuilt. That is a painful process.

 

Dr. Brian Hall said,

My question is how they counted “medical error.”  If a patient is admitted with multi-system organ failure or a terminal condition and had a medication error, is that counted as “causing death” because they died after the error occurred?  This was one of the big problems with the original IOM report.  They over-counted causality, based simply on the presence of error.

And even if an error did directly contribute to earlier patient death, it is important to quantify this.  Managing a patient’s cardiac failure may lead to years of additional life.  Preventing a medication error in a patient at the end of life may contribute to only a few days additional life in the ICU.  Before we switch from spending resources on disease, we need to have a better idea of what the benefits and costs of that switch will result.

 

Andrea Cahill1 day ago

So if you’re suffering from complex diseases or within a week of dying you deserve the error??? Surely you’re not that callous.

Vitor Goncalves said,

More scary than the poor study here presented (and I am aware human error does kill in the healthcare environment) as some pointed out right so, is the amount of professionals that can’t distinguish good research from outright sensationalism. 90% of those who commented are incapable of critically appraising a scientific article. I wonder how can you make the best judgement to treat your patients.

 

Dr. eugene saltzberg said,

@Vitor Goncalves why don’t you explain your critical scientific appraisal instead of dissing the group? I find the math here to lack real numbers!! Maybe I’m in your 90 %, but would like an explanation of variables and conclusions that seems to “jive”!

 

Chris Coats1 day ago

@Vitor Goncalves This was not scientific research.

 

Tina Schumacher said,

What is considered “systemic failure” in relation to medical error?

 

Dr. Deborah Proctor said,

Glad to see this published but wish it contained more data.  I can’t believe anyone’s surprised; what’s reported or reflected on death certificates is just the tip of the iceberg.  So much pressure to hide bad outcomes, force nurses et al to not file incident reports and in so many other ways bury the real data on what’s going on.  It’s a product of too little time and too much pressure to do as little as possible; remember to look for horses and not zebras allowing the zebras to just die off.  Would appreciate a follow up with breakdown of what the medical errors are.  I have a hard time attributing it to math skills as one comment stated; most of the calculations are now done in the pharmacy. The practice of  medicine has turned into a conveyor belt but we don’t have quality control folks standing along the line monitoring for errors and oversights.

 

JK Lenehan1 day ago

I agree completely. It’s better to publicize the information. Doctors are afraid of retribution from patients but admiring that mistakes can and do happen is part of good medicine. You catch yourself before you fall if you can but falls happen. Take responsibility for fixing what you can.

 

Dr. keumdje olive said,

Patients themselves come late in health centers

 

Dr. Walter Tucker said,

I don’t believe this article.

Dr. Luis Morales said,

how about ! People seeking late medical care as a cause of death.

 

Dr. eugene saltzberg said,

This trash has made it to the lay press. Medscape needs to write a SCHOLARLY retraction!!

 

Dr. Kathleen Meyer said,

If you look at the original article this appears to bean extrapolation not an observation. Included in what they consider errors appear to be maloccurrence and complications with disappointing results that are unavoidable. It appears to be not a useful number but more sensationalism. It is disappointing to me that it is not really about safety. This is grouping many different factors together and not isolated to physicians or preventable errors. It appears to me to be more about grabbing headlines than dissecting safety issues.

 

Dr. HUSSEIN EL-HASSAN said,

This is astronomical. A red flag. The government and every one associated with health care should be involved to be seriously committed to find out the cause and treat it.

 

Dr. Tomasz Helenowski said,

Looking at 4 studies performed 5-13 years before getting a multiplier of  35,416,020 in 2013 to extrapolate a figure of “251,454 deaths stemmed from a medical error” is not statistically sound. This type of fear mongering is dangerous sensationalism.

 

Clayton Frey said,

Your MD and GP are killing you! Come see a Chiropractor and we will appropriately allocate time and make sure YOUR health comes first rather then a check.

 

Dr. Greg Newman said,

@Clayton Frey A professional forum is no place for trolling. Even more so when the troll has poor grammar.

 

Dustin Tatman1 day ago

@Clayton Frey  I guess fake medicine is better than wrong medicine.

 

Andrea Cahill1 day ago

Are you saying you never refer people on… Bad practice old bean. Egotistical much!

Dr. joseph wamugo said,

The main problem is time allocated for viewing patients. Time to know your patients in public service settings does not exist. You need to see x amout of patients in a limited amount of time. Can we compare private and public mortality rates from medical error then we will see a major difference. People in the public sector are over worked exhausted lack of sleep then if course without addressing this issues that affect good judgment we will see no improvement.

 

Rhea Bayan said,

With that statement I absolutely agreed! In many cases, any great clinicians can absolutely clouded their judgement due to lack of time spent by nurses n doctors to each patients n including enough rest that each clinicians must gain within 24 to 72 hours work. Assessment takes a huge role as clinicians to execute a proper diagnosis, determine a proper n attainable goal n interventions as well.

 

Lori VanScoter1 day ago

@Dr. joseph wamugo exactly!  It is not safe that our new Dr’s (residents) are working 24 hour shifts.

Dr. Richard Free said,

Reminds me of the British study in WW2 designed to assign cause and effect to antiaircraft damage patterns on their returning bombers…reinforcing the retrospectively observed damaged hole areas on the wings didn’t change the number of planes lost …after all, the plane could fly home with those placed holes…until a young out of the box counterintuitive lieutenant pointed out that by reinforcing the UNDAMAGED areas of the returned planes, fewer planes would be lost over Germany…because indeed it was the explosive hits to the more vulnerable and critical UNDAMAGED areas that were causally associated with the inability to fly home and crashing into the ground…prospectively that lieutenant’s prediction was correct the BMJ needs that young counterintuitive lieutenant on its review board and perhaps we should be more cognizant of reinforcing positive survival benefit factors “the bounce back predictor factors” (can they get out of bed and ambulate) rather than too aggressive poorly tolerated treatment of negative risk factors with polypharmacy or chemotherapy that may predict greater morbidity and mortality in the last six months…and the emotional view that physician error was the cause of death.

 

Cheryl Rodgers said,

According to Guiliano and Niemi, one benchmarking study demonstrated a  67% error rate in administration of IV infusions. Another study by Bagnaso,et.al., demonstrates poor math skills in nurses and nursing students. I believe that a great many of the problems with medical errors stem from a disconnect in math education. We need to somehow make the connection and enlist K-12 Educators to assist with this challenge. Otherwise, we might have buildings falling on our heads in addition to being injured by the health care system. Dosage calculations require only elementary math skills.

References:

Giulano, K., Niemi, C. (2016). The urgent need to innovation in I.V. infusion devices. Nursing2016. 46, 4.

Bagnasco, A., et.al. (2015). Mathematical calculation skills required for drug administration in undergraduate nursing students to ensure patient safety: A descriptive study: Drug calculation skills in nursing students. Nurse Education in Practice. 16, 1.

 

Dr. JOEL CHAISE said,

Holding hospital administrators and taking action against incompetent ones would result in a major improvement

Often, lack of adequate number of ED MDs and hospitalists and using totally untrained mid levels have resulted in disasters in EDs since some ED chairs and their administrators just look at cost saving

Administrators making millions are never held responsible-just docs take the fall

 

Pacita Barker said,

Hospitals errors are not reported ! They are hidden! When you go tothe Az State Board. Meeting what is reported on the mistakes is just retail

 

Dr. Frederick Beck said,

I remain convinced that impaired “situational awareness” brought on by EMR’s and required irrelevant clicking is the biggest variable behind medical errors.

And I’ve read that younger doctors who are highly adept at multitasking may actually struggle more with this than grizzled veterans like myself!

 

sharon Flottman said,

@ Dr Frederick Beck- Agree 100% with your comment. When reviewing my EMR from 2 past (recent) hospitalizations, the errors in collected data was astounding and frightening. If a following healthcare worker used previously gathered info rather than collect their own, which is very time consuming, serious errors are bound to occur.

 

Dr. Frederick Beck said,

@sharon Flottman

Sharon,

I hate to say it, but I see what you describe all the time.  The amount of inaccurate information in EMR’s is both astounding and frightening.  Someone wrote a piece in one of the family medicine journals 3-4 years back coining the term “informational chaos” which describes it so perfectly.

I got hospital records for a patient the other day and it listed 3 different discharge doses of the same drug.  I saw another with severe angioneurotic edema from an ACE inhibitor, and it was still listed on the “Continue these Meds” discharge list (but the physician had firmly impressed upon the patient to NEVER take the lisinopril again).

But your points are well taken, these mistakes are incredibly common.  And as in a note above, “root cause analysis” is a vital exercise.  And this clearly  points to the EMR and the fact that we are overwhelming the poor health care providers in the trenches, and sadly so often with extraneous nonsense.

Fred

Pacita Barker said,

Went to see a nurse practitioner I was coughing and cannot sleep he gave me a prescription for Levaquin I did not an infection judt a virus I already have arthritis after taking it for seven days I have problem walking! right now I have so much pain getting out of bed!

 

Dr. Richard Free said,

PB..You are an educated pharmacist…the overuse of antibiotics is positively reinforced in the general self-referred public and by physicians that treat self-limited viral URIs within the first 14 days with almost any 10 day course of antibiotics…it’s not just the positive placebo effect of satisfied expectations…the patient indeed gets better most of the time WHEN they are swallowing the antibiotic pills…pretty hard to mentally refute that positive relationship with the typical 1-3 colds a year…but physicians may see 5-20 viral uri cases per day…they know this non-causal relationship of self-limited “cure” very well…the most common justification is that we are preventing “it” from getting worse…probably not very often…the highest level of over treatment is in antibiotic eye drops for viral conjunctivitis…most statins and baby asa numbers needed to treat are very high relative to any actual individual benefit as well, more so than antibiotics, OTC vitamins even higher…tv advertising of drugs is even more emotionally loaded…and consumer directed My question for you, is why did you go to the nurse practioner or an MD, PA, or DO, in the first place?…a virus is an infection…lasts 10-14 days…check your temp…put a rabbits foot or the antibiotic script in your pocket..up my way, pharmacists are even giving a multitude of injectable vaccines

Just ask WHY and say NO to antibiotics

Even small risks of harm outweigh medications and treatments with small or no potential for benefit

the absence of evidence… is not evidence “for” something

 

Dr. Shanhong Lu said,

Medical doctors are forced to see more patients per hour.  Our patients are sicker from stress and toxins they eat in their food….  It is time to slow down for physicians and take time to go over their medications instead of rushing around and being pushed around by administrators.

 

Katherine Beauchamp said,

chronic short staffing and 12 hours shifts, no kidding

 

Dr. Ninian Peckitt said,

This is what the British Junior Doctors strike is all about. A proper 7/7 service with 1 doctor doing the work of 2 doctors

 

Susan Reimers said,

Great topic, medical people overall want the best outcomes. Research with findings will prompt awareness and interventions.

 

Dr. AbdulKareem Hamzah said,

Dear Medscape

The common error in medicine, despite the progress and development Unlimited has to be
you must be know the mechanism of disease to avoid the error, and often to treat the disease according to the results of laboratory tests was whether or major complaint of the disease and this is considered a foregone conclusion. You must treat the disease from the base, not to be treated the disease from the apex.

With Regards

Dr. Dixie Swanson said,

As a patient, I require hand washing or gel in my presence. Whether you are the person who’s come to drop eyedrops in my eyes or change my IV. The outrage by the staff is just shy of Shakespearean. “But I just did it before coming in the room!” “Perhaps, but I require your doing in in my view.” If every patient demanded that, there’s be less “sloppy slap” of gel.

As a doctor, I washed my hands in the presence of my patients — well aware they were watching me. It is not only good infection control, it is a statement of the intent to take proper care.

I’ve been known to whip out my own hand gel and “offer” it.

 

Sara Fieberg said,

@Dr. Dixie Swanson  Great suggestion!  Your patients are lucky to have you. Often highly effective practices such as hand washing are overlooked. To readers, if you want a good read on how to reduce errors in general and medicine in particular, , pick up The Checklist Manifesto: How to Get Things Right  by Atul Gawande.

 

Dr. Stanislav Panfilov said,

It sounds very biased for me. Really, do not believe in this statistical erroneous article.

 

Dr. Edward DiCarlo said,

Some years ago, my institution joined a national “save-lives” program sponsored by Harvard.  After 18 months, were credited statistically with our share of saving what amounted to over a dozen lives in our institution because of heightened awareness of potential medical causes of death.  Our administration was ecstatic.  However, since we had no more than 3 actual deaths from all causes of our patients in any of the preceding several years, the medical staff was sort of surprised that we were able to prevent something of that magnitude despite our not having experienced anything of such magnitude.  We had saved lives that we would not have lost in the first place.  Statistics are interesting – especially when dealing with “extrapolation”.  Curiouser and curiouser.

 

Eugenio Arvelo said,

No doubt that a written assertion that a medical malpractice was the cause of death of the patient, will be seed for a legal action, not only against the doctor but against the hospital. Nobody is so ingenious to accept this in first plain.

 

Dr. surendrasingh nundoo said,

I was a resident in Maternity in the 1960’s .

Once the top Gynaecologist came for a Caesarian in the night . On being told baby was a fresh stillborn ; he said after closure of the Incision  << Its my fault  , I did not hear fetal sound before starting the CS . >>

 

JC Lord said,

@Dr. surendrasingh nundoo Your clear memory of this incident from 50 years ago has made you a better doctor. I’m impressed how such a moment can affect our practice for the rest of our lives.

 

Dr. vk sreenivasan said,

In our country, we have no statistics about the deaths caused by medical errors.Seldom do  we talk about

even iatrogenic complications

 

Dr. claire fabian said,

the conclusion is from extrapolation. Need better study before concluding that high volume of cases. Not to say that we can’t improve as a medical community.

 

Dr. MIchael Banks said,

So CMS ONC, this supports your notion that Meaningful Use and EHRs have been an improvement for patients in the US? I mean we have been doing that for the past 6 years, should be pretty good by now, right? So why is patient safety so bad?

Instead of tripling down on Meaningful use (got a new name too!), PQRS, now Clinical Practice improvement Activity, for the new MACRA rule, why don’t we try something different? In my eyes MACRA is yet another continuation of the nightmare of a room full of policy wonks, making policy that “sounds good’ but will never work in the real world.

  1. Stop all Certification rules for EHRs, let innovation come into the system. Providers and vendors do not need the nanny state of the US Gov deciding on what EHRs are certified.
  2. Stop all Attestation, Numerators, Denominators, Counting, mindless, needless burdens on providers.
  3. Start actually considering that if you want to save money that the physician is only a small part of the equation of the cost. Is it my fault the patient fell and broke their hip and their BMI is 50 and they smoke and and have diabetes? Will they have an increased complication rate? Why yes? So why hold me accountable for that? Maybe its time to ration (ouch did I say that) care, thats probably the only way this is going to work.
  4. Let providers work with vendors to improve usability, efficiency, SAFETY, security, and the patient outcomes will improve. RIght now we have Wash DC policy types that never see patients telling us what they think is important in patient care. I know what I need. I do not need a billing system that has a tacked on EHR, ladled with gov regs that are meaningless to me.

 

Dr. RICHARD KONES said,

@Dr. MIchael Banks

Absolutely right one. You are being conservative–the same should apply to most other areas of unnecessary burdens and sinecure-generating “jobs” for bureaucrats, pundits, and theoretical “talkers” (that’s a compliment for the real term).

Donna Carrillo Lopez said,

This is a systemic issue but is also a focus of attention in medical academics in this new era, which calls on academic healthcare settings to incorporate reflective thinking for trainees and for the institutions in which they train. Medical errors are thorny issues for all practitiioners but especially in a managed care environment that emphasizes ‘throughput’ of patients, maximizing business bottom lines at the risk of quality, patient satisfaction and safety and… the health of physician employees. The ‘system’ needs emergency care and policies need to be revisited with sober reflection if we are to remedy the issue and confront tort reengineering.

 

Dr. MARY ADUFAH said,

Great work done

. Strategic way, to minimize error will be good staffing ,less hours and less work load for doctors .

Thanks

 

Dr. Bruno Messmer said,

and what do you think the law people will make out of such open reporting, especially in the US???

Good luck!

 

Dr. Grazyna Wierzbicka said,

The numbers do not sound right. Well, probably more research is necessary.

 

George MacDonald said,

It is sad reading these comments. Instead of asking “what can we do about this problem?” most are variations on exclamations of denial…  Denial gets you, well, no where

Dr. Shanhong Lu said,

@George MacDonald YES We have a solution.  Slow down and treat patients -not become a part of the assembleline medicine slaving away our life.

 

Dr. Brian Hall said,

@George MacDonald Perhaps it isn’t sad as much as it is telling that physicians actually involved in healthcare recognize a poorly drawn conclusion from suspect data.  As a nurse I am sure you recognize that every “safety” and administrative requirement, while based on good intentions, often has unintended harm, if for no other reason than it takes away time from other aspects of patient care.  This kind of sensational claim gets the authors lots of attention, but may lead to worse medical care in the rush to “eliminate error.”

Of course we all want to eliminate errors that result directly in early death.  My suspicion is that this study isn’t teasing out the actual important errors and is simply lumping all errors together.  If you have a patient dying of end stage liver failure and the nurse gives the patient their medication an hour late and the patient dies, does that count as medical error contributing to death?  Should we spend hundreds of millions to make sure that no patient no matter what their condition ever gets their medications an hour late?  Or can that money be better spent?  It’s important to carefully evaluate what are the costs/benefits of every initiative.  Just because something is an error does not automatically mean that it should be eliminated “at all costs.”

 

Terri Lewis said,

Here’s the deal folks None of us are going to get off this planet alive.  But the quality of our days while we are here demands real work and partnership approaches in a rapidly changing complex world.  Root cause analysis and transparency WORK.  They are so much more effective and satisfying as a strategy than having to say ‘I’m sorry.’

Nothing will startle you more as a physician than when the day comes that you too are victimized by a poorly functioning system that has been designed not to work, and propped up by a profit generating machine that supports a few at the expense of many – including yourselves.  It makes your work so much more difficult and leaves you with feelings of anger and defeat.  It makes you hostile and suspicious of your patients and peers.  It’s hard to thrive when shame is lurking on your shoulder.

Correlation is not causation.  But if one spends any time at all in the WONDER.cdc.gov mortality data, there is a clear problem that runs through the data that needs to be understood.  We all know that wrong side brain surgery that leads to mortality is not death by brain tumor. Only when we understand the data we have can things like reimbursement systems be properly reflective of the work you bill for.  Good data improves your work. That’s an established fact.

That’s such a drag. Don’t be a hater. Be part of the solution – you too could be wearing this problem one day.

 

Dr. RICHARD BRANDON said,

What was not mentioned was that medical error is causing many of the first two leading causes of death. For instance, the provider placing someone on a statin without having them replace their CoQ10-their mitochondrial dysfunction leads to CHF as well as cancer. Another example is those doctors treating with beta-blockers or Metformin do not advise patients that those meds deplete the B vitamins and they need replacing. Deaths attributed to SIDS should mostly be attributed to vaccines. So-called recurrent breast cancer 5+ years after lumpectomy with clear margins, is usually the result of unnecessary radiation. Mammograms are associated with a 1-3% increased risk of breast cancer (each one). Hypothyroidism is associated with CVD, and there is an epidemic that is not being addressed, as the guidelines produced by the levothyroxin-makers, have been wrong for years. There are hundreds of examples.

 

Terri Lewis said,

@Dr. RICHARD BRANDON Yes.

 

c j1 day ago

@RB: I’ve asked repeatedly for my father to be put in ubiquinol post CABG cuz of age, health profile and being out in a statin. The cardio says there is no data to prove benefit and he refuses. Within a year, my father has developed heart failure, failed Lipitor, started on another statin once liver enzymes came down, fasting tryglycerides have risen over 100 and he refuses to do a HbA1C (and bone is on record). So, I couldn’t agree with you more.

George MacDonald said,

It’s not just errors…  It is also medication side effects (a BIG one!  Maybe bigger than the errors!) as well as lack of access to medical care.

.

But, the biggest cause of all is: Lack of Prevention.   No, make that a near TOTAL ABSENCE of PREVENTION!

.

The medical system views early detection and/or primary diagnosis & treatment as prevention.  It isn’t.  It is treatment of disease in its early stages.

Instead of focusing on fixing problems the health care system needs to shift to true prevention which actually prevents even the earliest stages of disease — and there is one and only one way to do that:

…Lifestyle Medicine — Teaching and supporting healthy eating and exercise at all levels and ages

Dr. Spencer Kronz said,

@George MacDonald Sad that the vast majority of commenters here who in theory should recognize this at least as well as you purely by virtue of their credentials seem to take quite a different and defensive stance.

 

Dr. David Magee said,

Just heard this on the national news- I’m sure tomorrow they’ll be malpractice ads on TV touting this “article”.

 

Dr. David Escalante said,

I do not know were is all this deaths are occurring I know that they happen,  as I have been out of medical school 30 years, I can only recount a few deaths that I can truly say were caused by errors. Recently I went to conference, when I ask a so call expert the subject  on a that was given lecture on the subject he brought examples of complications of a illness or a procedure as errors. We have a legal trend to blurr the line between  a complication with a error

 

Dr. claude varner said,

Can they define medical error?  I have been in medicine for 45 years and have not seen this to be even remotely true.

 

Patricia Sunders said,

I have a friend who had severe kidney disease caused by dye used in an angiogram.  Many years later, when hospitalized, he was given antibiotics for a sinus infection — by a hospitalist who did not know him or even check his history, and was given two antibiotics – Levaquin and Vancomycin, the next day he was unconscious with a tube up and his nose and down his throat.    The nurses in ICU said he “aspirated”.  His family sent him to hospice and he died a few days later, but if his kidney specialist or his family doctor had been allowed to treat him at the hospital instead of just the hospitalist he would probably still be alive.  The practice of allowing just hospitalists treat patients is not right.  They do not know your history and no one checks with your family doctor and if you cannot give your own history because you are ill or unable to fend for yourself you are at risk.  No one reads your history — or does no one care?

 

Vitor Goncalves said,

@Patricia Sunders there is poor coherence in your story and lots of details missing.You would have had my attention if you mentioned your friend required filtration for AKI, or that he was allergic to those antibiotics, but aspiration with a nasogastric tube inserted does not exactly  correlate with his kidney problem. Also no one call your regular GP or consultant to the Emergency Department and I doubt they would fare well in the hospital in many cases. Kidney failure caused by dye is still not always preventable. It’s a benefit vs risk decision. Why did your friend needed the angiogram in first place? And had he had previous kidney issues before that?

It is very easy to demonise others but you have little information to give about your friend case to make a solid assumption.

 

Dr. Mauricio Quintero said,

Cleary the study does not show causation, there is no way to prove that the error led to a death, i think this publication whithout real foundation will cause unnecesary panic

 

Dr. Richard Free said,

Start from the assumption that the vast majority of errors or “shortcuts” during treatments and interventions have no measureable impact on outcome at all; It is the retrospective logic process leading to assignment of causality “the legal smoking gun” that distorts the probabilities prospectively moving forward; we become driven and perhaps hide bound by well meaning cherry picked heavily biased “best guiding” principles; the randomness of large numbers of potentially lethel “trigger” events that include first and perhaps foremost the patients’ own unstable pathophysiology, but also the custodian that cleans the room, the nurses, the family, the physicians, the plumbing of the building, the pharmacists…it’s why we do prospective randomized clinical trials before we conclude there is cause and effect.

 

STARLINNE SULLIVAN said,

This is true. System errors, not people intent on making mistakes, is the main culprit. And it is true that tort reform is much needed, as many family members jump to punish for death, as they rightly feel the pain of loss.

 

Eileen Sharp said,

As a nurse who almost died in the recovery room following a complete hysterectomy, I can attest to the chain of events leading up to it that started before I even went to the hospital.  Misunderstandings and breakdowns in communication between a number of health care providers almost left my four children (ages seven to 12) motherless.  The good news was that it improved my own awareness of this problem and improved my nursing practice..  The other positive was that the hospital instituted a policy that the recovery room nurses had to contact the surgeon if any patient was not stabilized within an hour after admission.  The bad news was that I don’t believe that the chain of events phenomena leading up to my near death experience was addressed.

 

Dr. mira purohit said,

What was the definition of Medical error used to reach the stastical figure quoted?

 

Dr. David Magee said,

I guess people can just stop going to the doctor so they don’t risk getting cut down in their prime…

George MacDonald said,

@Dr. David Magee  That’s the best idea yet.

People should practice prevention so they don’t have to go to the doctor to get sicker or even dead.

 

Dr. Stephen Cox said,

@George MacDonald @Dr. David Magee Preventive health care is important, but it is unrealistic to claim that is all it will take to prevent diseases.  Your hatred of physicians is alarming and also unrealistic if you really think we offer no benefit to patients.  Perhaps you have better ideas how to educate future doctors since it appears in your bitter and warped mind that it is the only health profession that is not perfect.  Many patients and legitimate professionals do not agree with your vitriol with such broad generalizations against doctors.  I hope you get the help you need.

Dr. Stephen Cox said,

@George MacDonald @Dr. David Magee Many MD’s do practice preventive health education, even with less allowable time forced on them.  This is augmented with patient handouts. Many patients appreciate this and others ignore it.

Joan Zarbatany said,

Oh please, this is not news.  We’ve known about this for years.

 

Dr. Ron Lee said,

Here’s a link to the leading causes of death:

http://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2013-a.pdf

~440,000 “preventable” deaths

http://www.thenationaltriallawyers.org/2015/01/hospital-deaths/

I agree, this needs to be researched and acted upon where such things are truly “preventable” and are truly “medical errors.” Concluding deaths are attributable to “medical error” when the underlying condition was perhaps preventable or could have been mitigated by patient lifestyles may be somewhat misleading, depending on how significant the “medical error” really was – if the “root cause” was a condition preventable or mitigated by patient lifestyles, that may make sifting through this information more complicated.

 

Daniel McElroy said,

I believe the media, health care media, and health professionals should avoid using “Medical Error.”  It is too easy to dismiss such a study as individual physician errors or individual medication errors which are typically “caused” by a nurse.

Seventeen years after the IoM’s “To Err Is Human: Building a Safer Healthcare System” (1999), and 26 years after James Reason’s “Human Error” (1990), errors should routinely and correctly announced as:

“Healthcare System-Created Errors Are the Third Leading Cause of Death in US.”

 

Dr. Todd Bitterman said,

I can’t find the source of their data outside of theoretical probability estimates. Imagine the p-value that would be assigned were this a RCT of a drug. I would be much more interested to see hard data and not probability estimates and prediction models. We need to see fatal drug dosing errors and interaction mistakes, fatal surgical and procedural complication rates that are greater than commonly accepted low level risk, and see which ones in which types of hospitals by which types of providers. We need hard numbers to know where exactly to improve our quality and build system safety redundancies.  Good for all HCPs to have this fire under them though. Could be bad for folks who will sit on malpractice juries who may be unfairly biased, who may have a hard time understanding the medical details of a case in the first place.

 

Dr. Ron Lee said,

@Dr. Todd Bitterman

“We need hard numbers to know where exactly to improve our quality and build system safety redundancies”

I agree- this article should not be accepted with scrutiny – while real, definable “errors” should be addressed, I’m not sure such headlines are as “accurate” as they might be.

 

Dr. Rafael Nieto said,

I would like to know what criteria was used to determine that error was the cause of death. Being in this field for close to 40 years, I can honestly say that medical error is involved in a much lower percentage.

 

john levis said,

Yet another way for malpractice lawyers to continue to destroy the medical practitioners and skyrocket the cost of medical care.

 

Dr. Yusuf Saleeby said,

OMG.  But I am not surprised.

Dr. Yusuf Saleeby said,

Doctors’ strikes and mortality: a review.

Soc Sci Med.  2008 Dec;67(11):1784-8. Epub 2008 Oct 10.

Cunningham, et. al.

Abstract:

A paradoxical pattern has been suggested in the literature on doctors’ strikes: when health workers go on strike, mortality stays level or decreases. We performed a review of the literature during the past forty years to assess this paradox. We used PubMed, EconLit and Jstor to locate all peer-reviewed English-language articles presenting data analysis on mortality associated with doctors’ strikes. We identified 156 articles, seven of which met our search criteria. The articles analyzed five strikes around the world, all between 1976 and 2003. The strikes lasted between nine days and seventeen weeks. All reported that mortality either stayed the same or decreased during, and in some cases, after the strike. None found that mortality increased during the weeks of the strikes compared to other time periods. The paradoxical finding that physician strikes are associated with reduced mortality may be explained by several factors. Most importantly, elective surgeries are curtailed during strikes. Further, hospitals often re-assign scarce staff and emergency care was available during all of the strikes. Finally, none of the strikes may have lasted long enough to assess the effects of long-term reduced access to a physician. Nonetheless, the literature suggests that reductions in mortality may result from these strikes.

 

Dr. Richard Free said,

The birth of homeopathy (benign spa treatments) as opposed to allopathic (net negative) blood letting care techniques is based on similar improved outcomes and the emotional belief that homeopathic hospitals were superior….just the placebo hospital care and support mileu may be positive…so too may be staying home in your own bed with an array of home visiting services and remote monitor tethering.

Dr. marcon ali said,

Furthermore is there any data available regarding the number of lives saved by the caring medics by their extraordinary effort and devotion

 

Dr. Spencer Kronz said,

@Dr. marcon ali Maybe you could deliver those statistics in pamphlet form to the families of those damaged by medical mistakes. It could be titled “why you should feel good about taking one for the team”, with a picture of smiling parents walking out of the hospital with all of the family members they entered it with.

ellen raynsford said,

my experience with my family and friends has been horrific, Mostly due to the person caring them does not have time to really read a chart. Information is in there, the patient repeats it over and over but people do not read or understand contributing factors and information needed to help the patient.  As a nurse I had a social work ask me what my goal for my mother was. I said to get her out of the hospital alive as everyone I spoke to had a different idea about what was wrong with her. They did not see the whole picture. One time she was in the ER at Maine Medical for 12 hours because they were arguing over what floor to put her on, neuro or cardiac.

 

Dr. marcon ali said,

Whilst the lawyers must be having a field day,the medics are busy undermining each other

Is there any data regarding loss of a law suite due to incompetence or connivance of the lawyer?

 

Dr. Philip Huffman said,

Publication of this piece is going to be an important event for medicine!  I just don’t know if the effects will be good or bad!

The article is partly non-sensical.  Without a doubt deaths attributable to stroke, sepsis, and COPD far exceed medical injuries!  On the other hand, I can recall more injured or killed by the medical system than by guns or suicide which is tragic!  Moreover, most “errors” are attributable to limited system resources, profiteering, futile or near futile care, or contributory patient negligence.

At a time when UK physicians are going on strike and when we are in an election cycle I suppose one could be hopeful for a better US Healthcare system somehow resulting from this article.  I am a bit skeptical however as it just doesn’t seem to have a mature or completely truthful perspective.  It has a sensationalistic component similar to the “Pain is the Fifth Vital Sign” movement about 15 years back leading to the unintended consequence of the opioid mess we are in today!

The reality is that we are in a terrible demographic mess with our aging population and what we are in dire need of  more talented, caring, and virtuous medical caregivers  It’s that simple.

 

Donna Carrillo Lopez1 day ago

Philip,

Having spent a few years studying pain science, I can assure you that those of us in academic programs who brought attention to the need for appropriate pain management in our society would heartily disagree with your comment. The debacle we are experiencing today had much to do with aggressive marketing of the oxycontin,etc.by pharmaceutical companies, clinician naivete, and clinics who failed society by compromising the tenets of medical professionalism by inappropriate opioid prescribing patterns that were outside normative peer practice. Chronic pain is a challenge in medicine to treat successfully but integrative medicine offers solutions in creating plans to treat, guided by Cochrane studies and meta-analysis studies that have validity and are notably unbiased.

Dr. Philip Huffman said,

@Donna Carrillo Lopez

I don’t know Donna, no one here of good will wants for unnecessary suffering, I was just trying to make the point that sensationalistic movements not entirely grounded in reality often lead to poor consequences.

Dr. James McTamaney said,

The best way to categorize “medical errors” and assign them importance is to properly identify them by retrospective, individual chart review by a physician panel…..NOT collating probability data and then extrapolating the flawed data  until the final result becomes “scary” – but statistically meaningless. This is just a rehash of the old “Institute of Medicine” garbage that has become accepted as scientifically accurate because it has been repeated enough times in the media.

It is garbage.

 

Dr. Joshua Glassman said,

If Medical Error should be listed as a cause of death, then so too should Patient Error, or put otherwise Lifestyle Error, namely inhaled nicotine, over eating, sedentary living, and alcohol. What is the “cause” of COPD? Take out cigarettes and the disease would be relegated to the likes of Diptheria or Tetanus. How much of heart disease results from lifestyle decisions made and remade on a daily basis by the afflicted? If Lifestyle Error was one of those bubbles in the BMJ’s diagram, how big would it be?

Of course we give other titles to the cause of death, we describe the pathological processes that result from our way of life, creating names like COPD and Atherosclerosis. Moreover, thanks to articles like this one, we beat our chests and rent our clothes at the failures of our medical system to countervene our social behaviour.

I do believe that we as doctors and other medical care professionals need to take responsiblity for our mistakes. But we cannot take responsibility for sickness as a whole. What a wonderful world we would have in patients took responisbility for the way that they live their lives and industry took responsibility for the products they promote. Unfortunately, both point to the doctors and shout: Do something!

Starting a witch hunt to root out medical error is misguided at best, patently dangerous is more like it.

 

George MacDonald said,

@Dr. Joshua Glassman  Those are excellent points However, one that you miss is that the health care system neither educates patients nor supports them in making shifts to healthy lifestyles.  The closest it comes is ‘cardiac rehab’ — which happens after the fact.  It should be done before the heart attack and be renamed “Cardiac PreHab”.

 

Lisa Chelednik said,

Great point. That’s why I stayed away from the AMA and its, We want to manage you approach even though the road was clearly paved for me to join it. I chose the ANA and its FNP/DNP holistic approach. I know the for the most part the patient receives more of an education. Now, if they only applied it. But that’s another discussion.

 

Virginia Carter said,

I once worked for a hospital where punishment, suspension and termination were part of the culture. All this did was create an environment of fear in reporting, cover ups and very low morale. It’s starts at the top. Hospitals need to stop focusing on HCAP scores and start looking at the really important issues that we as health care workers are facing. When we hold administrators to a higher level of expectation and not just the nurses or doctors who put in overtime, work with no breaks, high census, high acuity patients, that’s when you will see positive change.

 

Dr. Thiago Irigoite said,

Studies like this must be seen with caution. I have seen this kind of movement against medical workers back here in Brazil just before the government  bring thousands of low paid physicians from Cuba. People who has never done a single test to prove their skills  to Brazil medical authorities. I am not saying there are not medical errors but that are political interest on blaming the doctors worldwide. Be careful.

 

Dr. Bill Mullis said,

a bs article

 

Dr. Bill Mullis said,

finding an error of some sort in the medical record  of a dieing person is one thing but calling it a cause of death is another.   sounds like an article written by plaintiff lawyers

 

Dr. J Peter Longabaugh said,

OK, doctors out there. Think of the last 20 patients of yours who have died. How many of them were due to medical errors? My experience certainly doesn’t match up with these data.

 

Martie Ames said,

There should be punishment for willful negligence.Which absolutely happens

Dr. Stephen Cox said,

@Martie Ames yes, unfortunately in all areas of life and all professions.

 

Dr. Peter Musoke said,

The legal fraternity must be opening their coffers wider with this story.

 

Scott Himler said,

Some errors that are preventable must be blamed on physicians that a still using pen and paper to write prescriptions with total disregard for their abysmal handwriting. If they won’t spend the money to use electronic tools, they will continue to be pestered by pharmacists trying to do their diligence to assure the patient gets to correct medication. The pen and paper doctors are dinosaurs in the current healthcare environment.

Dr. Anthony Gaither said,

@Scott Himler You have made a common assumption, that EHR’s are more accurate. They are not. You have disregarded the effects of “click” errors which are more numerous than those attributed to poor penmanship. Physicians are now routinely ignoring “warning” popups because they happen with almost every patient encounter who is on more than three drugs. Then there are the errors which occur due to information which is know to someone but not to the treating physician because it is buried in the EHR in a way which is too difficult to locate. And just so you know, at least once a month I get a pharmacist who prescribed the wrong medication from a prescription I sent electronically.

 

Dr. Steven Goldstein said,

@Scott Himler If you can’t read a prescription, you should not fill it. You should call the doctor and clarify it.  It will only take a few times before they will learn to write.  Eprescribing will have it’s own errors, and, depending on the system, can make prescribing quite unwieldy.  Unfortunately, nothing is perfect, including this article.

 

Dr. JEFF MATHESON said,

Here is a systematic error that could be causing long term harm.

http://medicalxpress.com/news/2016-05-cardiovascular-tool-overestimates-actual-chance.html?utm_source=nwletter&utm_medium=email&utm_content=ctgr-item&utm_campaign=daily-nwletter

 

Dr. Georges KHALIL said,

The health authorities and the healthcare system are both responsible for all leading causes of death by omission to do their job, and they should:

1-Support the prevention of chronic diseases and fund more research and conduct campaigns to encourage the public to adopt a healthy lifestyle.

-Make natural and non-processed healthy eating more available and cheaper.

-Encourage people to improve their physical activity level and making it a priority to healthcare providers and other institutions.

2-Have a better control over the food industries, man-made environmental pollution and GMO’s.

And what about the tobacco industries? Should they continue producing and selling their “killer cigarettes”

 

Dr. cornel balan said,

I am a neurosurgeon  – we all have BIG ego (if you know the difference between God and a neurosurgeon – God doesn’t think of himself as neurosurgeon)

In my not so humble opinion, the paper is right – we seldom acknowledge our mistakes, consider that it’s the disease, the patient or so…but there is a SILENCE rule which does not allow comments due to risk of being sued for malpractice. Even with my colleagues, I trust their lies, they  trust mine, that’s the general rule

There was an article like 5 y ago about the neurosurgical intervention on the brain on the wrong side (left/right) – despite that the patients did not die, the doctors were VERY reluctant about telling the truth – and it’s normal. The risk of being sued and ruin my career does not allow me to tell the whole truth or the number of cases I made a mistake – and I speak of mistake, not errors of judgement

 

Dr. David Magee said,

I’ve had patients die over the years, mostly from cancer. I can’t think of one that died from a medical “error”. Call me skeptical on this one.

 

Dr. khalid hashmi said,

Errors and negligence should be clearly seperated.

Errors could be errors of interpretation,or those caused by system failure.We have to be careful when recording ” human error”.There can be many confounding factors. I hope we donot open Pandoras box.

 

 

 

 

Martie Ames said,

Negligence is not requesting a patients prior records and not listening to your patients so they are misdiagnosed and not treated appropriately.

 

Dr. Michal Malinowski said,

If patient would not die because of medical error, he probably would die because of his disease. Thats the point.

 

Dr. Alen Salerian said,

Unnerving ,informative .hospitals are very dangerous places.be aware

Julie Goeres said,

It is not surprising. It proves the need for continual education. Updated quality and assurances. Reviews of practice. To assist in staving off those who profit on medical mistakes. Though I am a victim of continual malpractice for many many years. It amazes me how complacent we have become. I do believe women are being thrown under the bus. Substandard medicine in all disciplines.. We need…Good research. Good Listening skills… decreased ego …less bullying… Would help. Again stop the status quo. progressive care please..

 

robert sabbatino said,

Medical care and the entire health care delivery system is now in the fast lane. The cause-greedy doctors and hospitals. Life in the fast lane has risks; therefore medical care has more risk, for the patient. Members of the medical community shouldn’t feel dismayed, we also have a junk jutice system. In fact, almost all of the “systems” we have to help the citizenry are dysfuncional. Compassionate doctors, excellent example of an oxymoron.

Barbara Holloway said,

I don’t believe this for one minute, who are they kidding?

 

Dr. yvette martin said,

A very interesting topic. Wonder what the statistics is like in my country and in the Caribbean.

Tks.

Dr. Jamie Jackish said,

Sorry but I believe these numbers are total nonsense. It has been shown previously and repeatedly (curiously left out of this article) that the patients dying due to “error” are almost uniformly frail, weak patients whose life expectancies are short, eg 6 months or less. This is not healthy individuals dropping dead due to medical error. And the large majority would die to their conditions if it were not for major ongoing medical help. Moreover, I have noticed that previously “any” hospital acquired infection and “any” fall is considered error. WhIle I agree that reducing these events as much as possible is laudable it defies common sense and all practicality that these can be eliminated entirely. This is not a call to mediocrity, but I am indicting the methods used to calculate these results. Also the researchers “extrapolated” to the whole US based on 4 studies thus compounding whatever errors there might be. Too often people want a grabby headline but don’t really want to present the whole, more complicated story. In the meantime, people trust us less due to headines like this. So I urge a bit more responsibility.

 

Dr. Richard Free said,

Dr JJ..As they say, the road to hell is paved with good intentions…safety guidelines make sense…metallic oxygen tanks near MRI magnets does not require a clinical trial…stagnant water in remote hospital plumbing is important…sterile surgical instruments…accurate labs and blood banking techniques, etc…but when we, for example, adopt EHR systems that pile on more compulsive mouse clicking behavior and macro note writing at the expense of patient clinician face time because we think our notes are more legible and more legally defensible ? …I don’t think we have reduced the potential for all the “area under the curve” potential errors at all…we need studies that focus on all cause mortality under a variety of conditions, patient ages, inpatient care, etc before we decide to assign blame.

 

Dr. ahmad aldabetsaid,

Very interesting

Dr. al main said,

Poor design to extrapolate findings of 4 studies. More surprising that presumably smart people take this as fact. Too many assumptions made.

 

lisa nelson said,

Root cause analysis is not a “rapid” means for review.

 

Dr. Naseer Khan said,

An eye opener

Dr. Muhammad Tahir said,

Excellent effort

Most commonly ignored or mitigated cause of death

 

Dr. Richard Free said,

Simply put, if 10 interventions, attempts to cure, or intensively managed functional decompensations are required in a CAD -CA patient with an average 10% chance of death and a 90% chance of success, the CAD-CA patients will always move into the living category when successful;

10% die and are more likely to be judged to have died “during and therefore because” of the surgery, anesthesia, chemo, catheter, contrast dye, bypass, transplant etc….and many moving parts for actual human error for an unmanageable and terminal outcome event to have occurred…if not death, the 9 of 10 subsequent interventions will have additive opportunistic risk for a terminal “error” the more miles “driven” the more chance of a car accident too…the more potential attempts to cure, the more chance for team and individual patient failures Finally, if NOTHING is done to treat CAD-CA patients after their defining diagnoses…all will run their natural course and most eventually die and will be categorized as death due to their CAD-CA diagnoses…error numbers look good if NOTHING is done…CAD-CA numbers also look better if the patient is cured OR lives to go home and die in an airplane crash or some other cause farther down the list.

Therefore, the prevalence of CAD-CA death is high and management-related terminal events also appear high, but the error related death is mostly an illusion and an artifact of successful sequential management attempts….in an aging population.

 

Nfonba Alfred said,

Could a similar study be conducted in resource limited setting

 

Dr. Peter Musoke said,

I wonder too about stats where medical intervention is a luxury, where war poverty hunger and disease of all types prevail?! In my part of the world, trauma due to motor accidents, human violence especially murder, and HIV are the leading cause of premature death. Emphasis on “premature”.

Terry Lynch said,

The variants of grave injury and illness surely cannot be precisely directed, removed or predicted. Hind sight is always 100% as is all our chance of dying

 

peter Alphonsus said,

Involving pharmacist more would reduce such errors.

 

Dr. Sebastian Hillebrand said,

The right title of this article should be “Failures in the National Health System is the third cause of death in US”

 

Dr. Georges KHALIL said,

@Dr. Sebastian Hillebrand

I fully agree, and it should include insurances as healthcare providers

 

Dr. John Gillies said,

Very interesting article revealing a problem in patient management which requires urgent attention.

 

Dr. Nathaniel Ross said,

Am I missing something, here?  I already have trouble convincing my patients that their blood pressure medicine is less harmful than their cigarettes.  The hysteria that this article will create will only hinder our efforts to do the most good.  A lot of patients are already very suspicious of our advice.  For the suspicious, the article confirms their belief that we are all trying to hide something from them.

“Death certificates depend on International Classification of Diseases (ICD) codes for cause of death, so causes such as human and system errors are not recorded on them.” “Standardized data collection and reporting are also needed to build an accurate national picture of the problem.”  Then, how do the authors determine that medical errors are the third leading cause of death?  Very irresponsible.

In day to day practice, I see more death from strokes than death caused by medical errors.

 

Dr. Joseph Mooney said,

This really seems like a load of …well, you know what I mean…’we looked at 4 studies of death and extrapolated this number…’ Yeah, right! If that is the case then we are doing our jobs too well! If cancer, coronary disease, diabetes and a plethora of infectious diseases can’t kill us..we, the doctors have taken on this burden of ‘culling the herd’! I’m not saying that we don’t make mistakes…we are human. But if you believed this publication, doctors should be outlawed as to detrimental to the public’s health! This is the same type of nonsense that made antibiotic administration in 4 hours for pneumonia a benchmark of care…something that has nothing to do with anything…it all seems like poor science to hit what is a hot topic to further someone’s career…a not unusual phenomenon from this institution 😞

 

Dr. Ninian Peckitt said,

There is a certain degree of confirmation bias with respect to the diagnosis of error. It is a vague term with broad implications involving many aspects of the healthcare system and not just the clinical practice of the doctor. It is a subjective issue, related to healthcare policy, funding, service operational issues, such as delayed access to care eg through insurance issues. In the USA the referral of patients to appropriate specialists does not always happen as patients attend a chosen doctor by choice, regardless of the clinical relevence of that choice. As a resuly doctors sometimes work outside their area of expertise.

Human error is also a matter of opinion and “expert” evidence has been frequently challenged in the courts. Experts sometimes lose their own license if they make an error in court.

Clinical error when it happens is also not clear cut. It seems almost certain that this is under reported. People work their best when they are not under pressure and the defensive style of Medicine especially on the USA and UK is not conducive to “Best Practice” whatever that might mean.

The demands and pressure doctors suffer from a now litigious public armed in adversarial system with little emphasis on the inquisitorial investigation means that accused doctors are frequently defamed on anecdotal evidence. The absolute privilege that exists for witnesses making false allegations is a significant problem. In effect the doctor is guilty until proven innocent.

So the inclusion of error data is a double edged sword. Of course this data is very important. But the medicolegal consequences are a malpractice lawyer”s dream and a nightmare for Health Insurers, Providers and Doctors.

The current situation is a product of our own paranoia. The strive to perfection is laudable but in truth it generates system meltdown. The video recording of consent is a prime example of how dysfunctional the system has become. This lack of Trust and suspicion does not and has not created the environment for “Best

Practice”.

But it does create a system of discontent.

 

Zdenek Smrcka said,

In my opinion, the article provides an excellent evidence on the unperfectness of the human cognition (i.e. here: reading through the article) which results in that “human factor” (i.e. here: making readers angry for the wrong conclusions they had come to). Doing so, many readers have evidently ignored the last two key sentences of the article, which talk clearly abot the unsafe SYSTEMS and SYSTEMIC failures, not doctors nor the care provided to their patients. So, one should not miss the principle message of the article which might be summarized as follows. “There are two reasons for such a SYSTEM to be either unsafe or failing: it is too much simple or too much complicated. The deadly situation happens when a SYSTEM becomes BOTH too much simple AND too much complicated. And is not that just the case of the medical care in US?”

 

KUMARESAN U.D said,

Quite interesting, yes medical errors has to be addressed,it will definitely help to improve the knowledge and patients health, further more.I feel.

 

Dr. K RAGHU said,

Doctors already facing legal tangles related to patient claims would be most unwilling even to admit let alone

put on paper any indication of medical error.

 

Barbara Benedict said,

I am a medically retired PA and I have had several medical errors that could have easily led to my death.  One was when a new nurse improperly reset my morphine pump with an extremely high basal rate at the change of shift when he had to do a drug count at the end of his shift.  I suffered a respiratory arrest.  Luckily he heard the alarm on the pulse-ox machine and did something about it rather than leaving it for the nurse that he had already given report to.  I have known of incidents where patients have died when nurses leaving their shifts have decided to do this.

The other time was when an NP decided to abruptly stop my TPN without weaning it forgetting that I was on warfarin and that she was also abruptly stopping the vitamin K in the TPN also.  I was too sick at the time to think of it.  I ended up in the ER with an INR of 11.  This is the real reason that medical practitioners aren’t so anxious to have these types of mistakes end up in reports, because they do not want to look bad.

Neither of these mistakes were anywhere in the medial records or medical notes in either case.  In fact the NP did everything she could to hide her many errors in my treatment to hide her many mistakes and mistreatment in my case, even committing fraud in my medical record.  The way things are done in the world of medicine, when this happens, there really isn’t much that can be done about it except report the individual to the licensing board.  What would you have done?  I didn’t report her,  I strongly considered it.  I probably should have.

 

Dr. Adrian Plaskitt said,

My engineer and aviation friends are amazed at how we work. (In private practice i guess – less so in hospital). That we are allowed to work alone, making critical decisions with no oversight and no review other than the patients’ satisfaction is contrary to any sort of training in aviation or engineering. There is little simulation training, no restriction of hours, and certainly no drug testing or serious medical assessment as to fitness for task. Education, while mandated, is voluntary as to content with no attempt to match education to deficiency.

For many life and death medical decisions there is no checklist let alone a co pilot.

When you get into a plane you know the pilot is fit, drug free, has had adequate simulation training for possible rare emergencies, and has rested enough in the last 24 hours to be on the ball, and has a copilot to double check and discuss his actions.

When you step into a doctors office you know the doctor passed a medical exam 20 years ago, and attended the requisite number of CME lectures per year that he may have snoozed through. Oh and paid his registration of course!

 

Dr. Ninian Peckitt said,

But errors such as never events are not necessarily related to ignorance and lack of CPD training. Setting a morphine pump at the wrong rate is not addressed by CPD training but it might be addressed but not necessarily prevented by better staff/patient ratios less stress at work and different work practices. Loss of license won’t solve the problem; it just shunts it somewhere else.

As long as health care is dependent on human endeavour to do repetitive tasks, there will be error. It is what makes us human.

Negligent / careless error with attempted cover up is a different matter.

The fact remains that the more pressure is put on the workforce, the more error is likely. We need to optimise working conditions to get the best out of staff and we need to understand that human error will always be a factor in health care as long as the workforce is human.

The current system is oppressive and counterproductive. This makes error more likely. Health care can never be made safer for patients under these circumstances.

The mistrust of doctors will worsen and that this will result in more defensive medicine with an increase in error. This whole process is counterproductive and crushes human ability to perform. We are all victims with our obession for perfection.

There is no such thing in any task involving human skills.

It is to be noted that in the automotive industry quality improved as the dependency of manufacture moved from human to robot. And we will see the same in health care especially in relation to repetitive tasks.

But there will still be human error….. and if we don’t accept this we are not living in the real world.

 

c j said,

Obviousely, this article has hit a nerve. While always appeciating candor, I find some of the clinician posts here disturbing. Coming from the Northeast (and no, JH is the Mid-Atlantic so please do not confuse the two areas), I don’t need a study to know what goes on.

When process fails, it needs to be identified & investigated so it doesn’t happen again. Otherwise, it becomes an issue of what one can get away with. And the end-goal in that game is not what good medicine is about.

Unfortunately we have gotten ourselves to a place where there are not enough checks & balances. And sorry to say but the nature of healthcare delivery today does not elect or culture personalities that naturally lead the system in tandem with self correction on an individual or institutional scale….until forced to. That’s not a good way to function.

Personally, I think the record/communication issues we have today….which DOES contribute to errors… is a result of competing healthcare entities. Yes, they are competing for the patient’s ‘business’ …which is their health issue. So much energy and money is wasted through this competition. When the system has such challenges, quality of care / outcomes diminishes and mistakes increase.

No one is licensed or accredited to damage patients. So why not self-monitor and fix the issue? If there were no mistakes, it wouldn’t be a problem for anyone.

I remember late ’94 & early in ’95, we had a problem in the Northeast. Before it was publicized, I had spoken with someone at that hospital and came home scratching my head. I had a very bad feeling about how things are being done there and actually expressed that to a few people. Soon aftet, we all learned that a person had died due to the wrongful administration of chemotherapy agents. There was no self reflection that was going to happen in that hospital (on its own) and it would have functioned the same way had it not happen to a married couple, a research scientist and a journalist. Another patient died.The hospital was forced to close down all beds. And the ‘fixing’ began. Only then, when the cat was out of the bag, did they utilize their full capacity to change and do better. But it was SOLELY because the error had been made public. See:

https://psnet.ahrq.gov/perspectives/perspective/3/organizational-change-in-the-face-of-highly-public-errorsi-the-dana-farber-cancer-institute-experience

More recently in Boston, a doctor went on a campaign to make changes in the training of GYN surgeons in reaction to the outcome his wife, also a clinician, who underwent a myomectomy only to be dx’d with late stage cancer soon after with her prognosis GREATLY reduced due to the technique CHOSEN bythe surgeon. See:

http://www.bostonmagazine.com/health/article/2016/03/20/amy-reed-morcellation/

Please note the all out resistence of the culture to change and exogenous pressures that have forced it. This is in the same city, nearly the same hospital, as the one in the first story above.

(Note: I had the same operation at another teaching hospital in ’98. The surgeon explained the morcellation would be utilized but surgical technique would prevent contamination for the most part. So Hooman is correct in insisting that more advanced surgical technique should have been AND COULD be utilized.)

I think the resistance in the comments here is a microcosm of a culture that can make mistakes but resist the hard organizational and individual work required to acknowledge them and make changes goimg forward.

I hope this gives pause to reflect.

 

linda vardaman said,

@c j i could not agree more.  Thank you for posting.

Dr. kianoush saberi said,

thank you

It is informative .

Dr. Barry Gendelman said,

As a retired pediatrician, I like you, witnessed medical errors. Choose any field of work. Now tell me which one has no errors. Of course doctors make errors, some from exhaustion, some from not taking the time required,some from ignorance, etc, etc The comment earlier about parathyroid disease is telling. Of course it is easier to diagnose after five years have passed.

I have had various health problems for the past fifteen years. I can think of perhaps three or four doctors that did a complete physical exam when required out of probably twenty or more. Ask what hurts, order lab tests and CT scans, and write out a prescription. In my training I was taught that if you listen to the patient, he/she will tell you what is wrong with them. The general rule was that a good history provided 85% of the diagnoses, physical exam 10%, and lab and x-ray 5%. I believe that, if practiced, is still true.

I tried some “moonlighting at a pediatric urgent care. I had to resign because, with the EMR system, I could spend about 5 minutes with a patient, and then 15 minutes entering useless information into a computer that hated me and would buck me off regularly. When I say “useless” I mean having to choose which box to check when none of them fit. But in the garbage goes. You know the rest.

Now our biggest allies, the nurses, find themselves in exactly the same situation. They are able to spend, at best, 20% of their time at the patients bedside. The rest is feeding the insatiable computer. When I made morning rounds, the first thing that I would look at was the night nurses’ written note about how the patient was doing. Well, those are long gone. I was severely dehydrated from gastroenteritis a couple of years ago. After spending almost two hours in the ED, I was taken to one room for vitals, then another room for who knows what and then to the actual ED room. I was seen by a nurse practitioner and Iv fluids were ordered. After 30 minutes I asked about the fluids and was told that it has to go into the computer first and there were a lot of doctors and nurses using them.

And there you have it. The various Federal and State Agencies have converted warm and giving people into computer entry specialists. This has discouraged some of the really caring people (not all), and made a place for medical school graduates who care more about which specialties and procedures pay the most, than how can I most help this patient. And I am sorry to say that the worst is yet to come.

 

c j said,

@B Gendelman: Bravo! Well said however sad.

Dr. Richard Free said,

Medical interventions designed to treat cardiovascular disease and cancer are done on patients with a high risk of death without aggressive treatments, and that’s the reason they are first and second. If

Dr. Jon Naude said,

This article is pure lawyer bait. US medicine is going down the tubes if it finds this acceptable and the BMJ should be ashamed of publishing such articles. It’ll do wonders for the already uneasy doctor-patient relationships.

 

jim jones said,

“This is your doctor and/or nurse on drugs”

Let’s combine one fear with another for maximum effect and attorney compensation.

Dr. Jonathan Blitzer said,

What a mess!  Errors in judgment vs errors of omission vs errors of commission–no distinction.  Who is responsible for these errors?  From the tone of the comments on this site it appears doctors feel they are being blamed, but in a hospital there are many potential contributors to fatal errors.  Recently JAMA published an editorial on error in diagnosis.  What is the “gold standard” for diagnosis?  In many cases, there is none.  And so much of medical decision-making is dependent on statistics and probability.  In my field of oncology, a patient may have a 5% reduction in risk of death if chemotherapy is given after surgery for lung cancer, say, from 55% to 50%. If treatment is not given and the patient dies, is that an error, considering that the death rate for treated patients is 50%?  And would discharge summaries, or even autopsies, detect this as an error?

Many years ago, astronomers, marveling at the number of stars, mused that with all the potential planets out there, it would be probable that there would be life as we know it out there somewhere.  The response, in the popular imagination, was a wave of science-fiction movies with martians, aliens from outer space, etc.  The public is going to go similarly crazy with the wild extrapolations in this publication.

 

Dr. Mark Mann said,

…and this is science? So according to this, medical care (in the US) is analogous to Russian Roulette but with 2 bullets. What say we all consider aromatherapy?!

 

Dr. Victor Forys said,

Drs. Makary and Daniel are koko.

Dr. Chris Lowery said,

Not withstanding the horrible, “back of the napkin” extrapolation of unreliable and half-erroneous ICD code data, I am curious about something not described in the article.  I cannot find the definition of “medical error” when I look at the BMJ article that is linked.  I am not sure what definition the authors are using.  Clearly, surgery on the wrong part of the body, receiving the incorrect medication, or missing a diagnosis that is evident on a lab test or imaging study is a medical error.  But what about the complications from a procedure?  Consider this scenario – a patient undergoing high risk oncologic surgery, with infection risk factors of poorly controlled DM and ESRD on hemodialysis, who underwent a potentially life-saving complicated procedure later to develop an infection, sepsis, and later succumb to the infection.  Should this be considered a medical error?  We know that there are complications from surgeries and procedures, and that there are judgement calls about whether and how aggressively to treat certain diagnoses.  Unless there is an egregious fault in thinking or performance, or a trend for a certain practitioner or facility to have a significantly higher rate of complications, then I find it difficult (and irresponsible) to call these situations “medical errors.”

In the end, this is data mining for the sake of publication.  Certainly the medical community, and public at large, should demand strategies to reduce and eliminate true medical errors.  I do not feel that this article is helpful to achieving that goal.

 

Dr. Brian Beck said,

“Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics.”  Which means that the necessary data will be synthesized by making assumptions and then generalized to whole populations.  These conclusions are generated to make headlines and produce grants for further study.  For those of us who practice in hospitals, the rate the authors claim is counter-intuitive.  Our Hospital reviews every death to see if it was preventable and the number is nowhere near compatible with the study’s conclusions.

I would also take issue with the statement:  “The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used.”

No.  The medical coding system was designed to allow  Medicare, Medicaid and the insurers to deny payment for quality care rendered in good faith by physicians and hospitals.  ICD-10 was designed to provide data to bean counters and does not improve the quality care in the slightest.  In fact, it degrades the quality of care by occupying the time of physicians who could otherwise spend the time caring for patients.  ICD-10 proponents harbor the belief that Big Data will somehow reward us with marvelous (unstated, but nonetheless fanciful) benefits some time down the line.

Full Disclosure:  I worked half-time for my hospital’s IT Department helping to install its electronic medical record and the hospital paid for my attending their 20+ hour ICD-10 course with the hospital’s Medical Record Department’s Coders.

 

Dr. francesca brunilde albanese said,

Bottom line: if you get sick don’t go to the hospital there are MURDERERS in there. Sorry but the math in the article does not make any sense.

Err how did they determine that medical error was the cause of death? Little vague and scarce for such a scary prediction? No?

 

Dr. Stojan Pandov said,

In my country situation is the same.beside we have not exact evidence.

 

Dr. SARAH MANYAME said,

I think this is because you are mainly researchers and not clinicians! This is why you want to dwell on trivial issues just for funding which is a shame. How do you measure error?

 

Dieter Stalmann said,

It is interesting to see that the comments that are contesting this report, are from people with a Dr. prefix. Yes, we are working with people, yes we do make mistakes, yes, organs can fail, etc. However, if a doctor makes an error which was obvious, it should be dealt with as such. I listed 7 symptoms to my son, a veterinary surgeon. He immediately recognised the problem and recommended immediate attention. My wife’s GP, who recognised the problem 5 years ago, suggested ‘we should wait and see’. 5 years have passed and the hyper-parathyroid has degenerated my wife’s health. This type of error SHOULD be listed as an error.

 

Dieter Stalmann said,

Even if medical error were to be added to the coding, no-one would in reality front up to the medical error. My wife has been misdiagnosed 3 times in the last 8 years, in each case nearly ending up dead.

 

Dr. Diego Ortiz said,

Alarming + Inconsistent + Unreliable study… We are humans treating humans, err is undeniable! And the medicine today is going down and the health insurance “plans” are going up, such irony, isn’t it? so sad😦

 

Dr. MICHAEL TILLY said,

Not a surprise. We do the best we can with what we are presented with. Save many lives in spite of medical mishaps. Medicine not a perfect science. We deal with humans, not cars or airplanes. We are not automatons. Those who condemn us have not walked in our shoes. Diabetics, alcoholism, CAD, PVD, COPD, hypertensive crises, seizures, the whole enchilada. We cannot be made into some sort of computerized specialty. Non compliant patients, suicides, drug addicts. Try the ER sometime.

 

Dr. Jonathan Blitzer said,

@Dr. MICHAEL TILLY That’s what you think, Tilly!  In the interest of error reduction, that is EXACTLY what is happening.  In your specialty in particular, time outs and other robotic, automatic error control measures are now commonplace.  And the robotic checking of units of packed cells to reduce transfusion errors…that’s science, not art.  But it reduces errors.

 

Dr. Doug Lazenby said,

This article hinges on the 2004 HealthGrades study/article (ref 11. in the BMJ article) and uses the value of “0.71% of hospital admissions result in death from medical errors”.
That HealthGrades article (not peer reviewed but self published) used MedPar and AHRQ’s Patient Safety Indicator software, and looked at Medicare data (2000 to 2002) that scanned ICD-9 codes in 37,000,000 charts/admissions and applied some other methodology referenced in a 2003 JAMA article by Zhan and Miller to calculate the 0.71% figure. The HealthGrades article in the Study Limitations  section (page 9) also states the “reliability and validity of the analysis depended on the accuracy and completeness of the ICD-9 coding” (of the 37 million charts reviewed). As a side, 3 of the 4 most commonly occurring and costly PSIs (patient safety incidents) in this medicare only group (that would be old frail people) were decubitus ulcer, “selected infections due to medical care” (?), and DVT/PE (page 7).
Interestingly, the HealthGrades article stated that the incidence of PSIs (and death) were significantly higher in teaching hospitals and hospitals larger than 200 beds, not-for-profit hospitals and hospitals in the NorthEast region of the US. (page 6).
Makary (professor of surgical oncology at Johns Hopkins, a teaching hospital with 998 beds and 46,673 admissions a year), takes the 0.71% number (again medicare data 2000 to 2002), and applies it to all US hospital admissions for 2013 (Fast Facts on US Hospitals provided by the American Hospital Association-from article) This number was 35,416,020 admissions. Multiply this by 0.0071 (0.71%) and you get Makary’s death number of 251,454.
Makary in the article/paper gets “cute” and then suggests adding a field to death certificates to indicate medical error, and list it in the CDCs death causes to get it more scientific funding. He also has some worthless algorithm (“multitier” approach) to make errors more visible to respond/rescue and make less frequent. These steps are: institute safety triggers, make remedies available, foster culture of safety.
This paper is shamelessly self-serving, disingenuous and without scientific integrity.
But wait, let’s apply his number to the Johns Hopkins “raw data”. If there are 46,673 admissions a year at Hopkins (from US News and Report, 2016), that means that there are 46,673 X 0.0071 = 331.4 death/yr from medical error there. And that is not accounting for the greater PSI rate at teaching hospital (independent factor) (73% higher) vs non-teaching and larger (>200 beds) hospitals (another independent factor). Another risk factor (in the HealthGrades) paper/study was region; i.e., Northeast (that would be Baltimore, MD) had higher PSI rate than the national median. (page 5).
So 331 deaths/year (statistically probally more based on HealthGrades study that is being used as the benchmark) at Johns Hopkins Hospital is almost a death a day. I wonder if they are going room to room to ask the patients if they are going to be the one who is going to die that day from a medical error (I know, that was in bad taste, sorry.)
Makary needs to examine his little world first (and then report back) before making pronouncements on how to solve the US problem.
One more thing, in the BMJ article, they give a “case history for role of medical error in patient death”. Patient has transplant (doesn’t say what organ) gets readmitted for non-specific complaints, evaluated with extensive tests, including “unnecessary pericardiocentesis”. Goes home, comes back several days later with intraabdominal hemorrhage, arrests and dies. Post-mortem “reveals a ruptured pseudoaneurysm of the the liver where the pericardiocentesis needle grazed the liver”. Pseudoaneurysm of the liver?, I’ve never heard of that; pseodoaneurysm are associated with vessels, usually arteries, but not with the capsule of the liver and I have no idea how grazing the liver (surface implied with grazing) could cause a pseudoaneurysm. I hope the interventional radiologist don’t get wind of this. I can’t believe a surgeon wrote this.

 

Dr. Leslie Huszar said,

Again a numbers game and extrapolations. From what? This study fails to give  comparative numbers how many lives hospitals and doctors save. Interestingly the life expectancy another measure of how well medicine is doing has been steadily increasing.  In an age when talcum powder causes ovarian cancer and you can make 72 million dollars it seems to me the best way to close hospitals is to disclose details of medical errors and let them be sued. Then you eliminate the root cause of medical errors : the doctors and hospitals. Success: No hospitals , no doctors no health care  = no medical errors.

Congratulations to another well thought out study.

 

 

Dr. dimitris papadimitriou said,

If someone wants to see the problem face to face must to accept that the medicine today is in decadance.The defensive medicine,because of the insurance system and the commercialisation of the medicine plus the social decadance,we live,bring these results.If the medical community wants to correct this,the article is an excellent opportunity for us to criticise ourselves first and then to press for changes through our scientific organs for a medicine which is scheduled for humans not for customers of health products.

 

Francis Samuel Codjoe said,

Yes, most of these become from misdiagnosis patients’ diseases and errors during surgical operation that l am very much aware of in my country, Ghana.

Dr. Abdul Azeez Shaik said,

Hai, it is not medical error but it is the natural phenomenon where organs not reacted for recovery. Matter can neither be created nor destroyed.

raj yadav said,

Guud job

Dr. Jose Luis Leal Fernandez said,

Bad article with a lot of bias. For sure the deaths directly atributable to a medical error should be lower.

 

Dr. Roberto Illa said,

Of course the new corporate model (medicine is a business)  system will not record the increasing error

rate. “Mid-levels”, J1 Visa doctors, and poorly trained U.S. doctors, all under extreme financial, EHR,

and time pressure will drive the error rate up and the cost of care up. Not to mention overpaid

administrators  enforcing assembly line/”sweat shop”  work. .  How do ICD 10 codes improve patient care? Right. They don’t.  The De Salvo and ObamaCare ” solutions ”   have crippled independent doctors financially and drastically reduced the number of available primary care doctors and specialists.

“Protocols” rule. One of my patients who has a history of Nesidioblastosis had another hypoglycemic

stroke (hemiparesis). She was given tPa and treated as a “vascular stroke”. CT angiogram negative

however, ….but non-contrast MRI showed many “white matter lesions” (hypoglycemic infarcts). No one

called me from the ER or hospital. . No hospitalist contacted my office for medical records which show random and excessive  insulin production consistent with Nesidioblastosis (and insulinoma) and repeated episodes of hypoglycemia.

Apparently none of these “providers” consider a differential diagnosis or listen to what the patient

and family is telling them their “regular doctor” has already found. By the way….my experience is

that, at least, 3/4 of TIA’s and “strokes” are not due to vascular occlusion but hypoglycemia. See

UCLA report that in California 50% of the population has a blood sugar disorder. No… Dorothy. there is no such thing as “pre-diabetes”.  See my website and book at http://www.chicodiabetesdoctor.com.

If you have the normal range for blood sugar wrong (all commercial  labs ) ..and the basic paradigm for how to classify  blood sugar disorders wrong; (ADA dogma)….how in the world do you hope to reduce medical errors?

Roberto Illa, M.D.

 

Dr. Deborah Wardly said,

when I was practicing, protecting my patients from bad doctors was a DAILY endeavor.  as far as I’m concerned, this IS caused by poor attention to detail by doctors.  the insurance companies are definitely to blame by creating an environment in which doctors are always rushing to see enough patients.  but it is a personal choice by the doctor, to let this control you or not.  to work for a company that penalizes you for taking the time with your patients to address their issues.  also the specialization of medical care is another problem.  I am just glad I can be my own medical home and protect myself from the “good intentions” of my doctors who really don’t have a clue about what is going on with me or my children.  to make it unethical to treat yourself or your family when this kind of thing is going on, is the epitome of hypocrisy.  it is just dumb.  I’m sorry, but a doc is going to have much better attention to detail regarding himself or his own, than his doctor.

 

Dr. chris hanley said,

3rd leading cause?  behind complacency to bad reporting…  along with forced slavery to EMR’s and the non-clinical setting clinic guidelines

 

Dr. Daniel Allan said,

I wonder how many medical errors result from the EHR Daniel Allan, MD, FACS

 

Dr. john iceton said,

Ridiculous sensational irresponsible reporting. If anyone has read the studies involved,it is anything but scientific. Should be in the national enquire along with big foot research.

 

Dr. Andrew Gordon said,

I’m sure our legal brethren are just licking their lips in anticipation; to err is human, to sue is divine

 

Dr. Dale Dalenberg said,

This ridiculous story does not deserve a headline.  Medical error is not a diagnosis like heart disease or cancer.  So to say it is the 3rd leading cause of death is comparing apples to oranges.  How did this study determine that the actual diagnoses that caused the deaths were due to medical errors?  Did they include every death where a chart review showed any medical error, no matter how trivial?  And what were the causes of the heart disease and cancers that they were comparing to?  Shouldn’t we be comparing causations of diagnoses in order to compare apples to apples?  For example, how do medical errors compare to smoking, accidents,

Motor vehicle crash report
Do medical errors cause more deaths than motor vehicle accidents?

alcohol use, etc?  You can’t list medical errors on a list with diagnoses like heart disease, cancer, and lung disease, because medical errors are causes of diagnoses, not diagnoses themselves.  Bad study, bad news, unnecessary alarmism.

 

Dr. yahya juma yahya said,

Good study

 

Dr. Cheri Blacksten said,

If they are successful in convincing the world we are evil money hungry demons who callously murder patients then it will be easier to execute us (in the pocket). Who wants to pay the villain MD/DO when they can see the wonderful holistic midlevel. They forget they high cost of medicine is NOT my measly salary but the seven figure salaries of insurance execs and all those wonderful folks making up crazy rules that they require us to follow even before the ink dries. What ever happened to real science? Medscape is about to be deleted from my reading list

 

Sharlott Faulkner said,

So you can extrapolate deaths by medical error simply by studying admission rates. I find that interesting. I withhold any further comment.

 

Dr. azura azura abdul hamid said,

Agree with you

 

Dr. azura azura abdul hamid said,

Agree with Faulkner

 

Dr. Erik Kistler said,

Sounds to me like the 3d leading cause of death in the U.S is wildly specious claims using pooled database studies. Wonder it isn’t number one.

 

Teri Baird said,

Maybe, just maybe if we put all our medical staff back at the bedside instead of insisting that enormous amounts of ridiculous, time consuming documentation be completed the error rate could decrease.

 

Dr. Joseph Hosner said,

EMR and government oversight is surely the way to prevent medical errors….not!

 

Dr. Craig Davis said,

Good medical care is the leading cause of longevity. Don’t play loose with the data!

 

Dr. Francis Wiederman said,

I do not believe it.  These people are liars with an agenda.

 

Gail Henderson said,

I was admitted 1 said,  for simple, laproscopic appendectomy. My medical conditions are few but I’ve had multiple surgeries. The physician owned medical center’s anesthesiologist popped his head in the pre-op area long enough to say, “Do you have any questions for me?”. I should have asked why he didn’t have any questions for me. 40 min surgery and 1 hr recovery going directly from stretcher to car probably qualifies this as a Drive-Through procedure rather than “day-surgery”. There was no phone call; no nursing follow-up the next day. 36 hrs post-op, I developed chills, fever and increased abdominal bloating. A call to my surgeon suggested I get checked out at the nearest hospital ED. 48 hrs post-op, I was found on contrast CT to have large retroperitoneal hematoma with Hematocrit going from 13.4 to 7.2. Transfusions followed and I stabilized. I was discharged with a Hemoglobin of 10 and diagnosis of “anemia” and a belly full of blood. IR was unable to evacuate hematoma. Medical error, mishap, bad luck? I may never know but I do know one thing – accountability and documentation is critical. Doctors own this little surgical business and I had a drive-by “simple” abdominal surgery. You put the pieces together and decide the definition of “scrutiny”.

 

Dr. Cheri Blacksten said,

I am sorry for your experience. But please know your insurance company and CMS guidelines control who gets to stay the night usually, if doctors were allowed time at your bedside, they likely would have kept you inpatient (hey that would get them more money if they kept everyone for one night $7-900 easy profit while you sleep off the meds) doctors are rarely motivated by moving people along like the fast lane at McDs

 

Logan White said,

@Dr. Cheri Blacksten so true. If only lay people knew how much care (or how little care) provided is due to insurance and not the providers.

 

Gail Henderson said,

@Dr. Cheri Blacksten Thanks for feedback. I agree docs aren’t motivated to move us along like McD’s fast lane and my surgeon acted appropriately but there is a disconnect between benefit of tracking “processes” and reasons for creating them in the first place. Admin/Clinical research background makes me concerned that we are top-heavy with data collection that has not translated into provision for this grey area of needing to treat with caution as part of true patient care.

Dr. David Truong said,

@Gail Henderson This is called a “complication.”  Not the same thing as a “medical error.”  You’re a nurse, right?

 

jennifer manson said,

@Dr. David Truong @Gail Henderson You don’t think the lack of follow up care was an error?  It was purposeful?

Dr. William R Schroeder said,

Astonishing! This is incredibly poor science at a minimum. As once said in the movie Cool Hand Luke … “Morons … I have morons on my team.”

 

Galen Jackson said,

I can already see the potential outcomes of such a pronouncement (which is not a surprise, even to many of us who disagree with it). This determination doubtfully refers only to the deaths in which a medical error led immediately to a patient’s decline and death, but rather would also likely include ‘errors of omission,’ and others that contribute to a patient’s already-downward spiral, which ultimately end in the death of a patient. Those are not deaths caused by medical error, but will undoubtedly be included in such a definition, depending on whether those conducting the study are seeking research dollars to “fix” the problem.

Further, the “remedy” will undoubtedly be even more charting accompanied by more layers of bureaucratic oversight (supposedly to reduce such errors and minimize exposure to lawsuits– it will do neither), which will only increase the stress of caregivers and reduce their effectiveness even more than HIPAA and ACA already have.

Studies including this type of data need to be conducted on a local basis, in order to have any hope of improving the situation at all. Otherwise, the overall data might impose unnecessary changes on excellent facilities, while not adequately addressing the needs of poorly performing ones. I caution against acting too hastily on this information.

 

Dr. patrick mulroy said,

I’ve been involved in inpatient hospitalizations for 20 years now. I have been the medical director of a rehabilitation facility for most of that time. I can honestly say that in 20 years, I have seen very very few medical errors that resulted in death. More times than that, I’ve seen people die after falling on assisted. I honestly don’t know what these people are talking about

 

Dr. Chagai Dubrawsky said,

To Err is Human???.Unfortunately ,yes. Can one ERR, if it is within the Animal Kingdom? Yes it can, but it will pay dearly, instantly. It will pay with its own life. It will exist no more. It will be eaten alive!.

How come that animals evade mistakes? Animals think and respond instantly.Why can’t we human do the same?

Brett Mason said,

This is a glaring report card on the results of our government’s “vision” has influenced medicine in this country.

First, with respect to “management” and so-called “positive” direction, at a staggering cost of billions, the error rate has increased.  I suppose it will take another $40 billion to get us up to the second leading cause of death.

Second, with respect to what this administration has allowed to happen passively, its destructive influence has now also been measured.

It is ironic that the very reason given for central management–“improvement” and “elimination of ——-” is now graded using the same standards.

 

Dr. Andre Kruger said,

Indeed statistically throughout the 20th century, each time medical practitioners went on strike, the affected population’s mortality rate dropped.

Donna Miller said,

I had an aunt who died directly from medical assessment error.  I know as a nurse with 32 years experience, she was septic, not just dehydrated – at least according to new “sepsis protocols”.  I didn’t get all the details until after she was gone.  I tried to press the issue with the hospital but since I was not the nearest NOK, I was ignored.  I did not approach her husband due to his age and grief.  I don’t want legal or financial punishment.  As I included in my communication with the hospital, I am just after recognition of error and correction of practice – better education of nurses, better patient teaching that would possibly have prevented the infection, increased 1:1 education for patient’s with little education, or even concern other’s will think they’re stupid (my aunt).  Her answers to question, “Do you understand this information” was ALWAYS, “yeah”.  Her actual understanding was little to none.  She’d go for her chemotherapy appointments, and that’s the depth of her understanding.  I could go on and on about the lack of teaching and care and follow up.

 

Logan White said,

@Donna Miller The education of RNs is not the issue; the nurse pt ratio and the schedules/hours are problems for nurses.  These have been found to significantly increase mistakes

 

Brett Mason said,

This is a glaring report card on the results of our government’s “vision” has influenced medicine in this country.

First, with respect to “management” and so-called “positive” direction, at a staggering cost of billions, the error rate has increased.  I suppose it will take another $40 billion to get us up to the second leading cause of death.

Second, with respect to what this administration has allowed to happen passively, its destructive influence has now also been measured.

It is ironic that the very reason given for central management–“improvement” and “elimination of ——-” is now graded using the same standards.

Dr. carlos santivanez said,

Medscape ashamed of putting in your Website .

Sadly you have become the National Enquirer in Medicine.

Please spend  time reading and be thoughtful before publishing such as poor article

God bless America. Please !!!!

 

doc fitness said,

@Dr. carlos santivanez you can’t handle the truth!

 

Dr. patrick mulroy said,

@doc fit give me a break this is a Bologna article and you know it.

 

Logan White said,

@Dr. patrick mulroy whether the results are erroneous is not what we should focus on. We should focus on the fact that multiple medical errors are made, decreasing health and increasing health care costs. We need less chiefs (administration) and more workers (doctors, nurses, techs, medics)  For profit hospitals are consumed with operating with Skelton crews with minimum supplies.

 

Dr. Edward Katz said,

The first limiting factor should be a decision to treat a patient medically and at what level.

 

Dr. Michael Mueller said,

I trust that on the added line will be listed all the patient’s self inflicted disorders.  Obesity, smoking, poor compliance to medicinal and surgical therapy, self inflicted gun shots, high diving off of elevated areas onto hard surfaces, failure to respond to treatments in spite of all efforts, etc come easily to mind here….as well as med and surgical errors. Surely this is a work in progress. The insurance carriers’ actuarial tables will be very helpful in guiding med ed toward all of these .  Really!!!!!!

 

Dr. Timothy Michals said,

Extrapolated data to further indict my profession. I question the conclusion that any medical error was directly responsible for a patient demise. How exactly was this determined? I’m certain that medical errors are an issue that deserves attention. And I am all for quality improvement. On the other hand, it seems that we are the subjects of ceaseless criticism, and given more paperwork, more people to answer to, more boxes to check off, and this study will undoubtedly give the powers that be another foil with which to gut the practice of medicine further with yet more forms to fill out, and auto populated documentation. I’m counting down the days until my loans are paid in full, and I can shift out of this fiasco.

 

Logan White said,

@Dr. Timothy Michals I could not have said that better.  Indentured servitude it has become for those of us that got in the profession to make differences in pts lives, health.

 

Dr. MARTA ZELWIANSKI CHERNER said,

Medical error is too serious an issue to invent numbers by extrapolation. That is the same as assuming a data that cannot be demonstrated by other means. We assume nothing in medicine. We check raw data and investigate without bias or assumptions. Otherwise,we will make errors that don’t deserve publication.

Having said that,however,doesn’t take the burden of the fewer than stated,but real medical errors we are witnessing lately. The percentages are less than the article suggests,but for the patients,families,doctors and institutions represent a 100% failure in each case. Primum non noccere is what we all sworn when be become doctors,but sometimes is almost unavoidable. The system in which we are forced to work is formulated so we are set to fail. Too little time with the patient,too many checks on lists,too many breaches in the gathering of information. Too many different providers that do not communicate with each other but with a computer. There is no narrative and no continuity in a medical history anymore. Most medical errors are avoidable by having an accurate list of allergies, injecting Insulin with the meal and not hours before the patient is fed, checking the doses by weight and age, double checking that meds and patient are on the same list,etc.

I was a patient recently admitted for epigastric pain and vomiting. My stay at the hospital was for one day. I was overdosed twice with omeprazole,at the ER and the observation unit. There was an entry of wrong medication given,but no name of the said medication. There was another entry with the recommendation to delete the previous entry of error!! There was a lab report of urine C&S but I never provided a urine sample and no Foley cath was ever inserted. All this info was known to me because I requested a copy of Medical Records to check if my outrageous bills were compatible with the care I received in less than 24hs of admission. I guess I am too strong to succumb to the ills of modern medicine but others coul be not that lucky.

We need to stop and reckon and remediate before the inflated statistics of this faulty paper becomes a reality.

 

Dr. patrick mulroy said,

Overdosed with Omeprazole?? What an idiot. What did they give you two instead of one?

Thomas Baldwin said,

This since insurers and business models have been dictating how medicine is done and medical schools have cowed to them by actually training doctors to put business models first and clinical skills last.

This needs to be reversed now while there is still a living generation of physicians who know how medicine is supposed to be done.

 

Brett Mason said,

@Thomas Baldwin  Absolutely right on.. Amazing how most of the comments are defensive.

These data have little to do with physicians–they have to do with out-of-control management by people who have wasted massive resources to put tens of thousands of offices up–to do what?  Have the Docs on the other side of the phone wait for approval or denial? It’s a house of cards that must be brought down entirely, then eliminated.

I had the pleasure of reading an agency’s tomb the other day about models and proposals from 2007.  Of everything that was said, probably at the cost of several million dollars, there was not an iota of proof that anything in there ever worked anywhere. There were many in that series.  Now in 2016, there still isn’t any proof that any of those useless words and pages did any good.  In fact, more paper-pushers were using that material to create more of the same. These are the new medical doctors of politics and fluff. They are the problem.

 

Logan White said,

@Brett Mason @Thomas Baldwin let’s go as far as removing mds from the equation. The business model of hospitals is what’s hurting us. As someone aforementioned, it’s a system designed to fail.

 

Dr. Timothy Grau said,

A really spectacular example of Garbage In, Garbage Out.

If you’re in healthcare, take just a moment to think of all the patients you’ve seen die in your career.  Depending on speciality, it can be quite a few.  I’m sure in the vast majority you had a pretty good idea of what they died from.  Now how many cases can you think of where it was a medical error that killed someone?  While any medical error that kills someone is an absolute tragedy, it’s patently obvious that it is no where near the third leading cause of death (I personally doubt it’s anywhere near the top 20).

I couldn’t help but notice that within just a few paragraphs in this article we went from “deaths directly attributable to medical care gone awry” to “investigation into deaths to determine whether error played a role.”  “Played a role” and “directly attributable” are significantly different definitions.

Unfortunately, the attempt to overhype this and garner spectacular headlines ends up detracting from what would otherwise be a laudable goal.

 

Dr. Hugh Wilson said,

First, the study cited in this article is apparently a meta-analysis and we all know the potential problems with that study design: search and selection biases being chief among them. Secondly, this Medscape article says nothing about the selection criteria for the meta analysis nor how “medical error” was defined in any of the studies included in the meta analysis. Nothing. Not a word. Silence. Crickets.

This article makes the absurd claim that “The medical coding system was designed to maximize billing for physician services…” Every practicing physician in America knows just how silly that claim is. CPT was designed to first, standardize terminology and secondly to give regulators data with which to minimize reimbursement, not maximize it.

The article quotes Jim Rickert, MD who is President of the  Society for Patient Centered Orthopedics. That entity’s own web site describes their mission thus:  “We advocate for a system that offers all Americans universal adequate health care. We believe that basic care is a societal responsibility…”

Clearly Dr. Rickert and his organization are proponents of single payer healthcare and have an incentive to paint fee for service medicine in a negative light.

This Medscape article is horribly flawed and also serves as an attempt to diminish the public perception of modern American medicine. I would encourage everyone to read the meta analysis themselves and seek out the biases therein.

 

Richard Rendall said,

The findings that medical errors produce a high mortality rate comes as no surprise to me. There is no Medical Profession any more; the “Profession” has been converted into a large business. Not many years ago we had patient centered care now we have a corporate profit driven approach. In order to have any type of surgical procedure the patient (now he is the customer) must see an endless number of specialists so the surgeon can protect himself from unjustified litigation. I spent my entire working career in the medical field. While still in high school I worked summers as an orderly in a small community hospital. I spent a good deal of time assisting a pathologist with gross autopsies (I understand not many are done anymore-cost prohibitive), how any person can become a Doctor without this type of experience is beyond my understanding. Often the pathologist would mention to me “this is where the attending missed the diagnosis”, this was not to bring punishment against the patients doctor, rather it was a learning experience which allowed others to avoid the same mistake.

After college and some time spent in Vietnam I secured employment with a cardiac pacemaker company and devoted the next 35 years to helping cardiac surgeons and cardiologists care for their patients. Since I had earned the doctor’s trust and devoted 100% commitment to his patients wellbeing I was given wide latitude in my work. I worked a 24/7 emergency schedual until I was 100% disabled in 1998. At the time of my disability my earnings where $300,000 per year, $800.00 per month for any care I wanted (always drove Toyota Camerys), and full medical benefits. I can tell you in complete honesty I never went to work one day for money; my purpose in living was to see people recover and return to a happy healthy life style and until someone can show me how to put a money value on a human life I don’t believe I will change my thinking.

Today the young doctor enters medical practice with an education debt he will spend the rest of his life paying off. He doesn’t have his own practice, rather he is an employee of some corporate medical group. The money goes to the corporation not the doctor. Due to the over specialization, no doctor is able to consider the whole patient-customer.

If I should have a serious illness I have no doubt I would be dead long before I made my way through all the necessary nonsense to receive proper care. There is an old saying “The doctor who treats himself has a fool fora patient”; although I am not a doctor the is the position I am in today.

Thank you for reading this.

Richard

 

Dr. Paula Lewis said,

I recently had a family member experience an avoidable hospital error in a  New Jersey facility.  This issue requires more attention and immediate steps for prevention.  I will like to participate on a committee to monitor patient safety on hospitals.

 

Dr. patrick mulroy said,

Did they die?

Paul Jacobs said,

To err is human, but will computers, remote monitoring sensors, & robotics be the primary care physician of the future? We know they will never make errors due to fatigue & overwork which is a current systemic problem as access to healthcare increases via expanded health insurance coverage through the affordable care act (“Obamacare”).

Dr. MITCHELL FOLBE said,

Just another in the endless ways to demean medical personnel. What a piece of hooey. I’ve seen plenty of people “saved” from dying only to perpetuate their misery. Just walk through your local ICU to witness it firsthand. The authors would have us believe that without medical errors, none of the deaths would occur–ever. I would love to see causes 4 through 10 listed.

 

Dr. Nathan Jorgensen said,

This is statistical extrapolation at its worst. Do we then further extrapolate that if people just don’t seek healthcare the overall US death rate will go down? Virtually all hospitals conduct root cause analysis for all adverse outcomes. When the authors suggest that hospitals consider doing root cause analysis, it demonstrates how out of touch with reality they really are with current practice. I’ve been studying adverse outcomes on the front lines for years and agree medical error is a factor in some cases; however, it is not anywhere near the magnitude stated in the article.

 

Dr. ESTEBAN BERBERIAN said,

I’d like to see the same standards used to demonstrate the efficacy and safety of drugs applied to this information. There should also be responsibility taken by those who recklessly spew nonsense and call it science (on this “peer-reviewed” national inquirer of medicine) for all the preventable deaths that ocurr in those who, heeding this plaintiff attorney’s wet dream of a report, do not seek medical attention.

 

Dr. santy pudjianto said,

Would you mind enlightened me about the method to detect medical error with data from death certificate and was the method valid and can be applicable in every hospital?

 

Barb Gentile said,

Even with residents in nursing homes, physician care is not critiqued, by facility QA or by regulatory bodies such as cms and state survey agencies.

Dr. Ashraf Moharramsaid,

Proper prevention should be directed on training nurses . I have seen my self killing medical errors from nurses

 

Logan White said,

@Dr. Ashraf Moharram Wow, as a nurse, I’m more than offended.  I could go on about correcting errors from doctors, mid-levels, etc., but we all catch each other or we should. To paint us with such a broad brush is insulting and pointing fingers is not the way to correct/prevent errors.

 

Dr. John Ogle said,

Clinically meaningless information here–even for broad policy makers.  Probably self-serving for plaintiff attorneys or some group trying to get more funding. Practitioners see these useless statistics as summarily unhelpful akin to when a death certificate claims cause of death was that “heart and lungs stopped” or “cardiopulmonary arrest”. The laudable but general goal to reduce systemic and individual error needs useful stratification or specification or else it is worthless.

 

Theresa Torretti said,

Thank you, well said.

Dr. david henderson said,

Having read the BMJ article, I agree that the conclusions are ill founded.  Such a conclusion requires some proper data.

Error does occur in hospitals, and in my experience the most lethal is failure to make the correct diagnosis in a patient with a severe life threatening  illness, such as a myocardial infarct.

I think there are both individual and systemic errors, which arise from a number of sources, but pressure of time, inexperience of front-line doctors, failure to take proper histories, lack of collegial communication, over-reliance on investigations and protocols all play a part.

Industrialists know that you can’t run a system at or above capacity because it will fail, but in health we do it all the time.

 

Paul Jacobs said,

I agree with dr Henderson that a systems approach is the best way to address medical errors, which can occur at several steps in the healthcare process involving nurses, data transmission & storage, patient communication, provider/patient ratios, drug/prescribing errors, history reporting & record errors, & drug-related problems, eg interactions, allergies, side effects, including insufficient training & integration of nutrition, exercise, & vitamin knowledge into medical practice. When a systems approach was used to deal with cockpit errors in commercial aircraft, improvement in safety was observed – involving something as simple as permitting a lower level crew member, eg a copilot, to abort a flight & overrule a pilot if an error was perceived, eg failure to de-ice before taxi. I once had a patient, a former physician, who refused her medication saying it was wrong & the nurse argued with her trying to get her to take it. Turned out another pt had a nearly identical name, accounting for this system error & the prescription was misapplied to the wrong pt., but cleared up by listening to the pt.

 

Dr. BERNADETTE BRANDON said,

” This article arose from discussions about the paucity of funding available to support quality and safety research relative to other causes of death.”

I think that says it all.  Talk about a conflict of interest.

 

Dr. Osborn Viegas said,

This must surely be an indictment on the standard of medical practice and needs urgent attention. As always, the underlying cause needs to be determined. Could this be related to the interpretation and reliance on new technologies often of no proven benefit? Medical conditions are invariably multi factorial and patient specific so the growing reliance on medical technology in my view is misplaced.

Transparency is always a good thing. Open discussion of such cases will often identify a deficiency in patient care and possibly eliminate the guilt felt by the individual doctor concerned. However, given the adversarial relations that exist between Legal colleagues, patients and physicians, this is always going to be difficult. Absurd and obscene litigation pay-outs have to be reviewed if we are to deter the consequences of litigation. We must strive to get all to understand the maxim “to err is human”. Unfortunately, we in the medical profession have given patients very unrealistic expectations. For example, the obstetrician’s boast that he has the technology to reduce the incidence of cerebral palsy has merely fuelled patient anger for the individual with a child who has the condition. There are many such examples in all medical specialties.

Thank you for this article. It adds substantially to the information that patients will need before accepting treatment.

 

Cynthia Valentine said,

If we went back to patient and Doctor relationships without the middlemen, regulators, CMS and insurance companies, so that physicians could practice the healing arts rather than the business of medicine,it would be a vast improvement.

 

Cynthia Valentine said,

What happened to the 500K lives campaign that was supposed to lead to transparency and reduction of errors??

 

Rene Neville said,

@Cynthia Valentine

Didn’t you know? They were all victims of opioid over-prescribing

Rene Neville said,

Who decides IF an ‘error’ even occurred?

Obviously it is not the clinicians who would actually Know something about Cause and Effect.

So, logically, the only way to stop this ‘third leading cause of death’ is to Not Practice.

Perhaps all healthcare professionals should simply stop working and let the know-it-alls and bean counters take care of the system?

I will wager that in less than 3 days chaos would ensue

Dr. Costandinos Tsagaratos said,

This is not necessarily a new idea.  3rd leading cause may be a bit difficult to show and there is certainly some sensationalizing in the article, however I remember learning back in medical school in very early 2000 that the number of medical errors that were estimated to occur were in the several hundred thousand each year and at least over 100 thousand patients died as a result of errors.  It is not that hard to believe when you are dealing with the human body which is such a complex system.  What we should be doing is looking at how we can use use data to our advantage.

If the FAA took an approach to managing the flying of airplanes the way the healthcare system runs, the third leading cause of death would be plane crashes.  Doctors are not super-human despite the public expectation.  Despite being trained to use a systematic approach to detection and treatment of disease, not everyone does so. There is a human component to this thing called being a physician and it can’t be removed completely.

We need a much more transparent system without penalties and significant tort reform to approach every near miss and every sentinel event — like the FAA.  If we would model healthcare around, dare I say, probably the only thing the government has done amazingly well with, how could healthcare not improve by leaps and bounds?  In addition to utilizing an FAA-based model, we need to start implementing diagnostic software which is based off of a central database. Radiologists are already using computer assisted mammography as well as computer assisted CT scans. Where are the medicine docs in this?

You all should really just take a quick second to go to your favorite search engine and type in the search term “20Q game.”  Despite it being an online kids game, this software essentially learns as it goes and is pretty darn good at guessing.  If you try it out, tell me how could we not want to implement something like this to help with diagnoses and treatments and overall healthcare.  There was also the IBM blue supercomputer which kept making a killing when it took the place of a contestant on Jeopardy, while not connected to the internet!  Imagine if we could take a picture of a rash and show it to the computer?

The bottom line is we kill people. I know I have, thankfully only during training.  At least the one I know about. If we can look past the garbage of this article and use the power we have as a group, we can limit the very little harm we do as compared to the enormous good, and the good we do can even become a bit better.  Based on this article, it would probably not be too bad a thing for all of us to just take a day or two off to get our lawmakers to see our points of view – that we need to make changes now to accelerate the improvements in care that have been capable for decades but out of our reach because of those standing in the way to make a buck.  I mean, if the government can have a shutdown for weeks at a time and the whole country doesn’t go up in flames, how bad could it be if we do it for a day?  And by we, I mean you.  I’m an ED doc.  I don’t know what the words weekend, day-off or holiday mean.

Best to all.

 

Suzanne Weinberg said,

Many hospitals apply “mortality reviews” as a means to learn from system mistakes. The errors should be seen within the organisation as a whole and in a multidisciplinary context.

Dr. H. Ramanath said,

I am appalled to see this statistic. If its indeed true, then major steps need to be taken to mandate the hospitals and other healthcare institutions to report medical errors in death certificates and take appropriate action to correct this cause of death.

 

Ronnie Burress said,

Maybe more staffing, regulated patient nurse ratio rates and better intrafacility internship programs might help decrease the numbers.

 

Dr. Thomas Morrow said,

I for one do not believe the data.  I saw a lot of people die during my career and knew if there was a medical mistake that was the true cause of death.  The number was much lower than this.

I suspect that the errors seen in these studies may have been a small contributor but not the entire cause.

I would like to see concrete examples of errors that cause immediate death that could have been avoided… entirely for at least 30 days.

Most are probably small errors that allowed death to occur a bit earlier.

The legal system would be flooded if these numbers were actually accurate

 

Dr. Scott Corin said,

All this error stuff is complete BS.  What they call errors is so broad, and most of them do no harm.  It makes great press and we get skewered for them, but this has no basis in reality

Dr. Enrique Viteri said,

in relation to medical errors do not appear in the international classification of diseases, I disagree with the author or authors. if a careful inspection is done I ask seek the literal “Y” of such classification. It is important to note that here might be possible interpretation of such classification for registration on death certificates. Thank you for your attention.

Dr. Skip Pridgen said,

This is utter nonsense. After 25 years of a surgical practice I remember any mistakes I might have made and none have resulted in a death. Also there are no-win situations which are far too complicated to cull in or out. Who decides that an error was made, a nurse, a reviewer. This is flawed beyond belief.

 

linda vardaman said,

This is not shocking to me at all.  I do not know what has happened to physicians and how they treat patients. I have seen some things in over 30 yrs that would support this data fully.  What happened to ” Do no harm”.  There is a complacency that some physicians have towards their patients .

 

Logan White said,

@linda vardaman What happened? Big pharma, insurance companies, the public not taking any responsibility for personal health, the view that pts are “clients” and development of medical care into a profit driven business by LAY PEOPLE…These are just some of the things that happened. Please don’t accuse physicians of inherently changing – it’s not nice and inaccurate. Btw, I’m a nurse not a doc.

Dr. Gabriel Williams said,

I went back to read more about the author and look again over the article. Shameful.  We have an established surgeon who would rather sensationalize medicine, be promoted on Fox then provide surgical care.  Too bad, Martin Makary actually seems adept, I guess there is a lot more money to be made from media appearances, and books than from difficult laparoscopic cases. For all the impressive feats he has established, Martin Makary is still a disappointment to me, he should first request that “research” factually involve research before he requests “more transparency.”

 

Dr. RAYMOND ACEBO said,

I guess we should all quit working so that respiratory diseases pass us up again.  We can stop treating all disease so we won’t look so bad as doctors.  It appears we have another study that is made up to make doctors look greedy and like we are all in it for money.  They seem to try to make it look like we don’t care about our patient’s.  I suspect the author has never seen a patient.

 

Dr. Keith Yimoyines said,

True. The only solution is: More lawsuits

 

Dr. Anuj Mehta said,

This is just getting to sensationalize stupid data. Extrapolating results from four studies that analyzed data they applied it to hospital admissions to one year. So stupid.. Analogy.. I saw 4 people out of 10 fall last week from skipping rope.. There are 6 billion people so 2.4 bn people fall every week.. That makes it the largest cause of falls.

 

Stewart Meek said,

Working in aged care facilities I have witnessed many many times doctors going from patient to patient in a large ward without washing their hands. Many of these elderly patients had staph and strep infection as well as from the infection that they were possibly hospitalised. The use of gloves was rare on many occasions.

 

Dr. daniel garcia said,

After 35 years of practice I’ve seen how easy it is to have an error if you aren’t 100% aware of what you do and order. I’ve seen changing a prescription by the pharmacist from Clorphenilamine to Cloramphenicol, been handled by the assistant 90% trichloroacetic acid instead of 2% acetic acid during colposcopy, up to handling by the assistant phormol instead of 0.9% NaCl to wash peritoneum during surgery (this last more than 20 years ago)! So be sure error is human, but if everyone is aware of that and critically observe other’s medical procedures, we’ll all benefit.

 

Chris Coats said,

This was a study trying to create more useless jobs. Would love to know how they extrapolated this data from charts. This would be like sleeping on the couch causes death. How many people sleep on the couch and how many have been found dead on the couch. Therefore a a certain number of people died while sleeping on the couch. Sleepiong on the couch will can kill you

 

Dr. John Mallery said,

Extrapolation? These results are a wild guess and this study isn’t very helpful. What kind of errors? Death from infection while undergoing chemotherapy for small cell lung cancer is completely different from being given a drug one to which one has an established allergy.

 

Elizbeth Alfree said,

And the 4th leading cause? Um, let me guess….Age? What an idiotic study.

 

Dr. STEPHEN SPICER said,

So, the next time one of your patients dies, remember there’s a damned good chance that you caused it. Now, how’s that rub you, Doctor?

Or do you believe that this article rightly belongs in National Enquirer?

 

Kevin Hollingsworth said,

@Dr. STEPHEN SPICER , et.al…..it is appalling to me how cavalier so many practitioners on this comment section are acting. It is really no different than an average, garden variety comment thread regarding what a Hollywood starlet wore to the awards ceremony, instead of taking this deadly issue seriously. Grown men and women, with advanced, medical and allied health degrees are sniffing and discounting the reality of healthcare-induced harm, when we ALL know it exists. Perhaps this (or any) single article is not the holy grail, but don’t kill the messenger just because you don’t like the message. The various practices of medicine, nursing, trauma care, surgery, pharmacy, pathology, radiology, antibiotic stewardship are becoming more complicated with the passing of every year. Denying problems has not, and will never make them disappear. Sadly, the take home message I am getting from nearly every “doctor” on this comment section is little more than “I don’t want to change anything because I might get sued.” Regrettably, if outdated methods of thinking and practicing are not addressed, you most assuredly will get sued. A more reasonable approach might be to embrace the aforementioned practices of the FAA, to root out and embrace all errors, ostensibly for the sole purpose of making the world a safer place. Simultaneously, working on tort reform is certainly a reasonable action to take as well. And as a hospital pharmacist, I don’t just “talk the talk” – ALL hospital pharmacies are now required to walk the walk.

 

Dr. Stephen Weiss II said,

All patients die regardless of our treatment.  Doctors are not Gods.  We can’t keep people alive forever or guard them against all eventualities.  I’ve seen a pharmacist kill a patient by confusing kilograms and pounds in a heparin protocol.  I’ve seen a pt die by being administered his wife’s medicine list throughout his hospitalization.  I’ve seen a pt die from a narcotic overdose on a medicine reconciliation form.  All these events could have been prevented by a hospital pharmacist but the pharmacist, doctors and nurses were all distracted by the government-mandated EHR that was supposed to enhance patient safety.  Kev, you greatly misunderstand our cavalier attitude—we’ve been disillusioned.

 

Dr. Erik Kistler said,

@Kevin Hollingsworth @Dr. STEPHEN SPICER

Thank you for your comments. No one on this thread, I believe, denies that errors don’t exist in medicine and that they may be prevalent. But what is an error? Pharmaceutical “errors” tend to be easy to track as they overlap with medicine compatibility, allergies, total dosing, etc (often empiric and unnecessarily rigid in their own way, and documented in the EMR). In the clinical realm errors are actions that fall below the standard of care for the specialty and region of study. How often does that happen? In my Department we track deviance from standard of care and we grade them on a scale of 1-3 (3 being specious, 2 being possible and 1 being likely). We get maybe 3 level “1”s a year; none of them involved with untimely death. Are some not reported? No, all deaths are automatically reviewed for possible medical error. Again, medicine is a complex system and patient pathology is complex; the nearby hospitals that I’m aware of all have something of the same internal review structure. The numbers may be different, but deaths due to medical errors are extremely low. Perhaps elsewhere in the country? In short, this piece comes across as an inflammatory attempt to cash in (literally) on an acknowledged problem that most of us have been working on very hard for many years with specious and frankly bullshit data; hence the vitriolic responses to the paper.

 

Priscilla Newcomb said,

add to your list of recommendations “listen carefully to patients.” I almost died twice from medical error, both times because the doctor did not listen to me and correct course of treatment. Having survived the worst, now when a doctor or nurse doesn’t listen to me, I walk out and I do not return to their care (or lack of care).

 

Dr. marc friedman said,

Sorry I simply don’t buy this. The vast majority of hospital deaths I’ve whitnessed over the years occur in elderly patients with Multiple morbidities. They succumb to diseases as their clinical course deteriorates. Things like sepsis and electrolyte abnormalities following multiple heroic attempts to stave off their decline are not medical “errors”. Nor are

Anastomotic leaks from bowel resections in gravely ill patients in poor states of nutrition “errors”.

If the hidden agenda is to triage the old and infirm this is the way to do it. Let’s just be honest about it.

 

WIll Reed said,

I would like to see actually what are the medical errors that are reported here. I think the only way to change this is to uncover our mistakes

 

Dr. Sherrod Shiveley said,

This is beyond a doubt the dumbest article I have ever seen. Please. If someone is dying of a natural process and we don’t manage to intervene successfully, we are now going to call it a medical error death? Give me a break.

 

Rene Neville said,

@Dr. Sherrod Shiveley

No one is allowed to die from ‘natural causes’ anymore!

 

Dr. Steve Hansen said,

Wow. So we could prevent 251,454 deaths a year by simply withholding medical care? Who would have guessed

Christine Carroll said,

That’s a response i would expect from a 10yo.

 

Dr. David Lounsbury said,

It’s a legitimate point. And your “rebuttal” does nothing to enhance your credibility. Let the doctors have their discussion and hold your peace if you have nothing of value to contribute.

I’m from Canada, but I wonder if anybody here has any pull to demand this article be pulled by the BMJ? A counter-response could be written in NEJM or JAMA

Kevin Hollingsworth said,

@Dr. David Lounsbury  Dr. David (Canada) Lounsbury: the forum does not exclude non-physicians from commenting. An old proverb: “There is none so blind as he who will not see.”

Kevin D. Hollingsworth, Registered Pharmacist

Dr. David Lounsbury said,

The non-medical credentials are a secondary issue. True, none (including pharmacists) are immune to criticism. I simply think we should be above random ad hominem attacks on a supposedly professional forum. Thanks for the quotation though – I’ve heard similar, but not that exact one.

The problem is that the physician-patient relationship depends so much on mutual trust. Half of what we do is to reassure patients and “wear their worries” so they can rest more easily.

Articles that erroneously claim that physicians cause more harm than good, and that we are directly responsible for so many deaths, threaten to undermine that trust. Patients may hesitate to consult their doctor and suffer in silence. Or worse, seek solace from charlatans practicing iridology and homeopathy

Dr. Steve Hansen said,

@Christine Carroll  Apparently you’ve been hanging out with some pretty precocious 10 year olds… but I agree, a child could see the obvious flaws in this poorly thought out and generally irresponsible article.

Dr. mohan pai said,

While it is important to shed light on issues such as this, writing a paper such as this will defeat the purpose.

 

Dr. Gabriel Williams said,

Garbage study.  The article refers to other articles for “estimates.”  Garbage in, garbage out.

The authors have incredible incentives to sensationalize the story and go with noncredible statistics for their own gain.  Their tenure and golden chute rest on how much political and media frenzy they create.  Imagine a true carnival of statistics, prime time, lies and recognition will follow.

I propose an internet based peer review that shares data and is open for number crunching by anybody.  This is deplorable medical propaganda at its worst.

 

Kevin Hollingsworth said,

@Dr. Gabriel Williams  …..and to all others who attempt to debunk this article. As an institutional pharmacist with a 33 year practice, I have seen so many anecdotal “errors,” both systemic, human, medication induced, physician induced, RN and Pharmacist errors, errors of commission, errors of omission, unapproved abbreviation-induced errors, “look alike sound alike drug errors,” RN override access to deadly medications in the PYXIS, etc, I lost count about 30 years ago. To attempt to deny that this is a very real problem in the US, and apparently worldwide, is denial at its worst, and in the grandest of all fashions, physicians who believe they can do no wrong – if ONLY everyone would just see things their way. Dr. Williams: welcome to the 21st century. Everything that ALL of us do, daily, is now under the microscope.

 

Dr. Scott Weaner said,

@Kevin Hollingsworth @Dr. Gabriel Williams

Anecdotal “errors” do not mean that they caused a death. We all have seen medication errors, but I recall only one that truly caused a death.

Dr. Scott Nelson said,

Systemic for certain.  If physicians were not overloaded with so much superfluous micromanagement directives from every angle and source, they could concentrate more on the mission critical tasks at hand.  So much of what was left to the expert, experienced, trained judgment (and yes, intuition) of the physician has been reduced to protocols, wherefrom we must stray not or face the consequences.  Following the protocols makes iatrogenic deaths look like complications on paper, therein lies the rub.  It happens all the time.  I was nearly killed by docs who treated a bleeding duodenal ulcer resulting in referred chest pain because the protocol said “aspirin and nitro”.  I had 8 negative cardiac workups with not a single belly exam, and the result was a 9 unit PRBC transfusion which only brought my Hb to 8.2 grams.  My oldest daughter was killed by chronic acetaminophen toxicity, having taken 2 extra strength Tylenol QID for a month plus the odd Midol and Nyquil, following a shoulder injury.  She presented to the ER with transaminases over 200, nausea/vomiting and RUQ pain, and the doc was too busy following a gastritis protocol to even ask about Tylenol.  36 hours later she presented in fulminant hepatorenal failure and shock, which was the first time I had been informed about any of it.  The doc who did this hadn’t considered glutathione depletion even by this time, and he was residency trained an board certified.  That I was once the managing partner of his group didn’t make this any easier to take.   Errors, fatal errors, happen every day and are buried in the semantics of protocol and process.  It’s getting worse and will continue to get worse until physicians regain their diagnostic/therapeutic autonomy, because no two patients are the same.  We have to be allowed to do what we do best.

 

Erica Parks said,

@Dr. Scott Nelson I am so sorry to hear of your loss…I can only imagine how it must feel to loose a child under those circumstances.  I agree about the systemic/structural issues…and I wonder whether these errors are, like you say, the result of protocol-based medicine, managed from above, at the expense of a proper history and physical exam.

 

Dr. Roberto Etchegoyen said,

If these studies are correct and if medical error is such a major cause of death, we should ask ourselves how much of these so called errors aren’t just the result of the interaction of a ever changing medical science and the always surprising phisiopathology of the desease.
It is hard to believe that doctors kills more than bacteria, viruses, urban violence and traffic. By accepting these conclusions we would do better by stepping aside and leaving the care of our patients to healers, xamans and others… Otherwise we will only serve as pasture to lawyers and insurance companies.

 

Jane Shriver said,

Unfortunately this will never happen because if it did hospitals would loose funds and become known for “negligence practice” on deaths that were considered errors. These things are mostly covered up and swept under a rug. No hospital wants to be known for errors, unsafe materials or equipment. Nor negligent doctors or employees, that could be enough to shut a hospital down!

I have worked as an surgical technologist for 34 years and have seen and heard may things. I have seen technology fail, surgeons falter, and accidents happen when least expected. I do believe systemically errors do occur and that somehow it should be addressed, but I also believe that many hospitals will not be as honest as they should.

 

Dr. russell shatford said,

“Although the assumptions made in extrapolating study data to the broader US population may limit the accuracy of our figure…”   Ya think?

Sensationalism, speculation, and assumption based on assumption based on assumption.

The case that they present sets the tone.    “Unnecessary tests”.  And how do we even know this this test was unnecessary?  Because they say so, with their 20-20 hindsight.  And how do we know that their numbers are right?  Because they say so.

I am very unimpressed with the quality of this article.  I think that it got published because it was something that BMJ wanted to hear.  Wonder how many journals turned it down before they finally found someone to publish it.  I would really have appreciated a thoughtful evaluation of this article.

 

Dr. Doug Lazenby said,

Dr. Shatford, my thoughts exactly. BMJ must be a schlock journal to publish this. If I was Cameron (at Hopkins) I would be livid about Makary publishing such self serving over reaching crap.

Dr. Douglas Campbell said,

It would be essential to have a list and definition of what is considered a medical error to fully understand the statistics.  There is a world of difference  between error, bad results and unintended consequences.  How much of the data were pharmaceutical and what were frank judgement /hands -on errors.  To fully understand this staggering claim it would be nice to knowthe categories.

 

denali riley said,

Putting “medical error” on death certs opens up a legal frenzie! If you think malpractice ins is unaffordable now

Dr. Maria Aljabi said,

This extrapolation of “data” and conclusion leading to ” medical records being the THIRD????…” Makes no sense at all

On top of that they said doctors are not listing their errors…(as the ” cause of death” ( “cover up” ???)so doctors not only are not skillful, but they have bad intentions as well?

if ” they did”???? Would it then make it the number one cause of death????

We are here to help patients, not to harm them

They need to put more money and resources in what is REALLY CAUSING increase in death in the USA:

“…progress for middle-aged white Americans is lagging in many places — and has stopped entirely in smaller cities and towns and the vast open reaches of the country. The things that reduce the risk of death are now being overwhelmed by things that elevate it, including opioid abuse, heavy drinking, smoking and other self-destructive behaviors”

 

Dr. Rich Greczanik said,

So extrapolating data is quality data now?

“We calculated a mean rate of death from medical error of 251 454 a year using the studies reported since the 1999 IOM report and extrapolating to the total number of US hospital admissions in 2013. ”

 

  1. Braun said,

To error is human….but 75% of all Rx drugs are consumed in the Us with the US population being less that 5% of the global population. Could it be we over prescribe? Three or four generic erythromycin take care of whooping cough..but how often is a more powerful antibiotic prescribed.  Just one example. Rather than be defensive..let’s open our hearts and mind’s and solve the problem. When we have almost 500 Black box drugs on the market..doesn’t anyone equate that to risky prescribing?

 

Dr. Noel Graham said,

I thought EMRs were supposed to prevent all medical errors

 

Dr. Thomas Benda said,

I would like to see the cases. This is incredibly hard to believe.  I suppose if you call every postop PE an “error”, and every complication in a critically ill patient an error, you might get there.  But not every postop PE is preventable, that’s become very obvious looking at SCIP data.  And yes, errors and complications are going to occur in critically ill patients.  I wouldn’t go so far as to call them “cause of death”.  There is no way medical errors are responsible for more deaths than trauma.  Again, show me the data.

 

karen howard said,

Simulation training that recreate errors will assist in RCA identification. Simulations on errors can also teach clinicians what ‘not’ to do.

 

Dr. Stephen Walker said,

No surprises here

 

Dr. John Foster said,

I read the full text of the article, and; significantly, it does not have a definition of medical error.  That matters a lot.  For example, for over one hundred years, we have known that pulmonary emboli are often not diagnosed ante mortem, and we have not yet figured out how make the diagnosis in all patients.  If a patient dies with an undiagnosed, untreated pulmonary embolism would that be considered death due to medical error, or death due to a cardiopulmonary problem?  I am in my 35th. year of practice, 27 of which have been hospital based.  I can recall a handful of deaths due to medical error, and some more close calls, but by far the greatest number of deaths I have seen have been due to cardiopulmonary problems, malignancy, trauma, and plain old age.  I find the authors’ conclusion that one in ten people in the Western world die from medical error incredible.

 

Paul Ernsberger said,

Autopsy results frequently contradict the diagnosis in the decreased patient’s chart. This means there is an error, but it is not necessarily a preventable one. Errors are inevitable in every human endeavor.

 

Dr. Richard Heather said,

Death certificates do not document the real cause of death. In California it is against the law for a person to die of old age even if they are 100 years old. I must write “cardiac arrest” or “respiratory arrest” both technically correct, as the cause of death. I doubt these numbers are real. You could look at a chart of any dying patient and find errors but most did not die “from” errors but “with” errors. Technically perfect care of dying humans would burden the patient, family and system with brilliant but futile prolongation of unsustainable physiology.

 

Dr. Mark Croley said,

Great points. Agree totally.

Dr. Timothy Angelotti said,

Technically cardiac arrest is not permitted as a cause, at least at our hospital in Cali. Must a more specific cause

Dr. enkhamgalan tsiiregzen said,

It is astonishing to see a health industry power like US faces a such scale issue with medical errors

 

Dr. Barry Mennen said,

The answer to this is clear: patients should never go to the doctor

 

Darlene Hight said,

Totally in agreement

 

Dr. emilio gonzalez said,

These are “system” errors although when advertised as medical mistakes the implication for the public is that physicians are at fault. Doctors are typically compulsive people and so are nurses; however, a lot of hospital operations are in charge by other people,

 

Dr. Mark Croley said,

This kind of publication is just plain irresponsible, hyperbolic, misleading, and in fact dangerous in its own right. Note that this is purely extrapolated data as is most of “To Err Is Human”, held as the sentinel for the safety discussion. There is little to no way to reliably tell that all of these estimated deaths are due to medical error which is what this article implies. I would agree that better reporting could help bur Dr. Rickerts suggesting that the death certificate should have a reporting field for medical error is poorly thought out. Who is supposed to determine that a medical error occurred and was present to such an extent as to be listed as a cause of death? The individual certifying physician?

Medical error as a contributing cause of death can only be reliably determined by a root cause analysis (if even then ) and of the many I have been involved with, even then more often than not you just can’t tell. You take a reasonable shot and identify and try to fix the problems you can. But not every death needs a root cause analysis.

Who then carries out this “rapid and efficient independent investigation”? And who determines what “independent” is? Outside lay people? Government mandated agencies? The notion of an independent investigation of every death is as impractical as it is unnecessary. This needs to be largely left to the self governing staffs of hospitals and other facilities who can use their own good judgement in the context of the local

situation.

 

Dr. Noel Graham said,

Amen

 

Dr. mohan pai said,

@Dr. Noel Graham

Amen for what? Do you agree with the authors of this publication? is the term medical error or death due to medical error clearly defined in the paper?  Have the y looked how many of those so called iatrogenic deaths were preventable in patients with end stage malignancy, cardiopulmonary causes?

 

Dr. Noel Graham said,

The amen was a reply to dr. Croley’s comment

Dr. Scott Weaner said,

@Dr. mohan pai @Dr. Noel Graham

I think that the Amen was referring to Dr Croley’s point, which I fully agree with.

Dr. Richard Lorraine said,

I’m not sure I have ever seen a more ridiculous conclusion in a medical journal. I will admit that I haven’t yet read the article, but I find it preposterous to assert that medical errors are the third leading cause of death.  Firstly, the actual definition of medical error is of critical importance to the conclusion that was reached.  For example, does a liter bag of saline that was supposed to be infused over 6 hours and instead took 8 hours constitute a medical error?  Secondly, can you identify a causation link between the so-called medical error and a death, or did the death occur unrelated to an error but was counted anyway?

I have been practicing internal medicine for over thirty years, and I have therefore inevitably had a number of patients succumb to terminal illnesses.  Of all those hundreds (?thousands) of cases, I am only aware of two where medical error played any role in their demise.  While I am aware that anecdotal reports like mine do not constitute epidemiologic evidence, the odds against my not encountering a higher percentage of the “third leading cause of death in the US” are astronomical.

By the way, when it comes to credibility, isn’t BMJ the journal that published Dr. Andrew Wakefield’s fraudulent study on the link between the MMR vaccine and autism?

 

Dr. Renjit Sundharadas said,

@Dr. Richard Lorraine I agree.  This is absolutely nuts.  Medical errors are a big deal and when they happen they are clearly known.  In practice it is very rare to hear of a serious medical error.  There is no way that there can be this many deaths attributed to medical care.  We need to look more closely at these “errors” because it is likely that they are too rigidly defined.  Such as getting a medication 20 minutes late.  I’d bet the vast majority of errors are trivial or nit picking.  The problem with this is we are always being portrayed in the media as being problems when the major problem and biggest causes of problems are the patients themselves and the poor decisions they make.

 

Dr. James Maher said,

I wonder how a medical error is defined.  If a patient has an allergic reaction, if a resistant organism fails to respond,  if someone gets an ulcer from an nsaid, or if no colonoscopy is done until age 52 and a cancer is found, are these medical errors, or is it only that a known allergy is overlooked, a heart  bypass proves fatal on a patient without triple vessel or left main disease, etc.  Are all deaths related to narcotic pain meds medical errors, or are the only counted deaths those where a prescription is filled too early?  It is disappointing that a subject so important fails to adequately define the critical term.  Medial care gone awry isn’t very specific, and many times a physician may have little control over how that can occur.

 

Rex Campbell said,

Pretty damning stuff for the current medical system. To be fair Doctors have a really tough job on their hands, and many do wonderful work, and help a lot of people, because they genuinely care. But there is great need for improvement here, and certainly a greater need for transparency when determining the cause of death so we can monitor and adjust our focus according to the data.

 

  1. Braun said,

@Rex Campbell  I agree!

Dr. William DeMedio said,

This article lacks “meat”. I do not see nearly the prevalence of iatrogenic death as described. Among all the deaths I have seen in the past 30 years, I can count all of the iatrogenic deaths on less than one hand. That makes this pretty meaningless to me.

 

Dr. eugene saltzberg said,

Fuzzy math!! If medical errors are not recorded on death certificates, and the # of deaths due to medical error is “extrapolated” from other data? Seems very”fuzzy” to me. After 36 years of hospital based practice I take issue with this “deduction “.

 

Dr. Larry GROSS said,

EHR systems were supposed to decrease medical errors. Seems this category is creeping up toward the top now that we are all using these amazing cumbersome systems.

 

Dr. carlos cobelas said,

don’t agree.   it’s always easy for arm chair experts using 20 -20 hindsight to say “errors” were made.

it isn’t reasonable for doctors to diagnose everything when there are not sufficient signs to diagnose it.

it isn’t reasonable for people to expect surgical procedures to be risk free, just like driving cars on the road

is not risk free.  just because a complication develops does not mean the surgeon made an “error”.

little wonder there is so much litigation in the USA with attitudes like this.   thank goodness I do not practise there.

 

Dr. marcel pidoux said,

That sounds totally ridiculous!

 

Dr. Saleh Ismail said,

This does not make sense. It is an insult to physicians to accuse them to be responsible of about 10 ٪‏ of the deaths. This is an exaggerated story.

 

Dr. charles drehsen said,

Amen to these observations. The medical profession should stop fretting over gun control.

 

MEI HAN POON said,

THE LORD’S PRAYER

Dr. Williams Burrows said,

Another article proving that via statistics one can prove that cow farts are causing global warming. HATE those cows.

 

Dr. JUAN ARREDONDO said,

Medical errors., are very common also here in Tijuana Mexico., just in the border to San Dieco Ca. USA., I work hand and hand with a lot of doctors in the state sometimes we see each other patients I am  a ENT surgeon specialist., ., The problem here in Mexico side is that the families don’t ask for Autopsia to find out the cause of death., and also the government don’t investigate the deaths in surgery., most common in plastic surgery., liposuctions., or heart disease., also we are no. one in children diabetes., so , this is a very large problem all over the world., We are trying to see the profetional titles of the doctors here., and also if their up to date on their board certified.  ( sorry for my English errors).

 

Dr. Dr Rama Jayaraj said,

Please read this

hana Morrissey said,

I will be interested to know if medication dispensing or prescribing error included in this figures and how much it accounts for or if this only covering diagnosis and procedures?

Dr. Barry Callahan said,

An “extrapolation” study. I call B.S.. Medical errors occur but cause of death at #3 doesn’t seem reasonable. All this does is give fodder for the lawyers. Good job, all news outlets will pick this up so they can bash doctors so more. That seems to be all medscape wants to do.

 

Martin Belitz said,

One major cause of medication errors is faulty interpretation of handwritten prescriptions. Regulatory bodies should impose a ban on handwriting prescriptions and insist that all orders be typewritten or computer generated. Far too much time and energy is spent with back and forth phone calls or faxes questioning handwritten orders. In this day and age of tablets, smart phones and computers there is no need for handwritten errors turning into mortalities.

 

Priscilla Newcomb said,

@Martin Belitz yes. Also, with computerized care including computerized prescriptions, doctors should be required to review FDA boxed warnings. These may change frequently without doctors or hospitals being aware of FDA reviews.

 

Dr. Vahe Akopian said,

I’m here to help people, but if what I’m doing is causing more harm than good, then I need to re-evaluate what I do.

 

Sharon Lundstrom said,

Once again litigation is the root cause of this “cover-up”. Fear of this prevents addressing this issue in a productive manner.

 

Dr. Carlos Garcia Rosas said,

No only in usa, is the problem, in many countries the Doctor not write the real cause of death, and they do not write that they did medical error to contribute in the cause of dead, because if they did, he will be in legal problem in the different countries,

 

Dr. Marian Bursten said,

I think the error is assuming all deaths are “preventable”.

 

Dr. ricardo nicolas said,

Remember the 3   ” C ” :

C ardiac

C ancer

C omplication

 

Mary Lane said,

No foolin’?

Dr. Aditya Mangla said,

These data are highly suspect. To determine that a patient death was due to a preventable error vs the initial medical issue is almost impossible to calculate. This type of study raises good questions, however the conclusions are theoretical only and should be regarded as such.

 

Dr. Daniel Purdom said,

You are now more likely to be killed by your doctor than your car. Unbelievable.

 

Dr. John Tuttle said,

Garbage study

Confounding variables affect mortality statistics
Why are patients dying in record numbers? Who is preventing people from investigating this? Is the punitive culture of state medical boards preventing transparency in healthcare?

To read more about medical regulation click here.

 

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