Medical Error as a Public Health Problem
Medical error seems ironic, almost an oxymoron. How is it possible – nay, even imaginable – that healthcare providers with a minimum of eleven years of postsecondary education in the health sciences commit mistakes in the course of life-saving ministrations? And yet, it has happened enough that in 1999, the Institute of Medicine released a report showcasing the data on this topic: at that time, 44,000 – 98,000 people per year died from medical error. According to a 2016 British Medical Journal report, more than 250,000 people each year died from medical error. The researchers for this report calculated this figure from the studies reported since 1999 and extrapolated to the total number of U.S. hospital admissions in 2013 (Makary and Daniel, 2016). While these numbers seem small (by comparison, the United States had a population of 323 million in 2016), keep in mind that these are deaths occurring at the hands of highly trained professionals. Suffice it to say that one death from medical error is too many, doubtless 250,000 per year.
Defining Medical Error
Medical error, however, does not implicate itself solely in deaths. According to the book When We Do Harm by internist Danielle Ofri, medical error results when an adverse event (that is, harm in any form) occurs as a result of medical care. Ofri illustrates this using a 1964 study by now-deceased internist Elihu Schimmel. The study examined 1,014 patients from August 1, 1960, to March 31, 1961, and sought to discover errors resulting from acceptable diagnostic and therapeutic measures (that is, not errors resulting from inadvertent errors). Schimmel found that out of 1,014 patients, a recorded 240 episodes of medical error occurred in 198 patients (1964). These included adverse reactions to therapeutic drugs, transfusions, acquired infections, and other types of medical errors. In the study, deaths resulting from medical error accounted for 8.1% of the medical errors found (16/198). Furthermore, moving beyond medical error in one hospital, Teitelbaum and Wilensky (2017) explain that medical error being viewed as a public health problem is new, with policymakers, public health professionals, and healthcare providers “paying increased attention to the problem” (235).
The Importance of Medical Error as a Public Health Problem
Why is it important to view medical error as a public health problem? The question can be answered from at least three perspectives: the impact on clinical healthcare, the impact on public health, and the impact on individuals. Concerning clinical healthcare, medical errors would logically be connected to loss of trust in doctors and the healthcare system. Moreover, from the perspective of the practicing physician, medical error may be connected to adverse outcomes such as depression, anxiety, guilt, and shame, further impacting medical practice.
Medical error also has an impact on the public health system. In a study from the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence, Newman-Toker and colleagues found that across all clinical settings, an estimated 795,000 Americans died or were permanently disabled by diagnostic error each year (2023). Prior research focused on errors occurring in specific care settings. Furthermore, according to a 2021 study by Aljabari and Kadhim, medical errors are associated with increased healthcare costs; “in a 2008 report, it was estimated that medical errors cost the healthcare system in the United States more than 17 billion dollars annually” (p. 1).
Finally, medical error also has an individual impact. According to a report from the Institute for Healthcare Improvement, National Patient Safety Institute, and the National Opinion Research Center, while most Americans report positive experiences with the healthcare system, more than half of those in the research reporting experiences of medical error identified long-term physical and emotional health effects said medical error had on them (2017). When one considers these impacts, it is clear that medical error is a problem worthy of resolution.
Causes of Medical Error
To understand how to solve medical error, it is important to understand the causes behind it. Teitelbaum and Wilensky (2017) explain that both concrete and abstract realities cause medical error. Examples from the former include failing to complete an intended course of action, implementing the wrong course of action (e.g., misdiagnosis of a condition leading to adverse treatment outcomes or engaging in an unnecessary medical procedure), and failure to maintain competency in one’s medical specialty (for example, through continuing education units). These, of course, can be corrected rather simply: for example, using a checklist to ensure that a procedure is followed properly; using the differential diagnosis procedure, and maintaining competency by reading books, journal articles, and attending conferences. What is arguably more impactful are the errors caused by abstract realities like unknown causes of diseases (consider idiopathic diseases, for example) and the culture of medicine, which is perceived as elitist, perfectionistic, and committed to rote memorization over personalization of conditions.
Solving Medical Error
It is known from the research described above that medical error can result in further medical illness or death. How can we solve this problem to prevent these issues?
It stands to reason that solutions to medical error are dependent on the cause of the error. For failures of omission, one solution is to develop a checklist for frequently completed procedures (Ofri, 2020). Furthermore, for issues like misdiagnosis, it is, of course, important to use the differential diagnosis procedure. While there is good reason for the medical dictum “When you hear hoofbeats, think horses, not zebras,” rare diseases are still possible, and their correct diagnosis can help improve the quality of life for people with the condition.
In addition, the law is a corrective to medical error caused by unnecessary procedures. While it is certainly possible to accidentally commit an unneeded procedure, the law, at its best, serves to intervene where unnecessary procedures are purposely done. It is a crime to commit fraud by billing for unnecessary procedures through Medicare, as well as procedures not actually performed. Such actions may result in the loss of a medical license, providing an incentive not to commit such acts.
However, how can we solve medical error through abstract causes, like the culture of medicine and unknown etiology? For the latter, the key step here seems to be the production and dissemination of research. Research is important to understanding the causes of certain illnesses, like rare conditions and mental illness. However, it can be hard to secure monies for it; this demonstrates that in grant proposals, highlighting the impact of said research on reducing medical error is paramount. Furthermore, once completed, research should be disseminated to medical journals and followed up on by physicians, perhaps through continuing education requirements.
Concerning the former, physicians should remember that while they are highly educated and thus justifiably respected, they are not infallible: they are human. To be human is universally to make errors in thinking, feeling, and behavior. Having this awareness increases humility in professional practice. In behavior, this could look like doing a consultation with a more specialized physician when one physician isn’t sure about the next steps in the diagnostic process for a rare or unencountered condition or reviewing the procedure before it is done to ensure it is correctly strategized.
Medical error is a public health problem, which at first glance makes it seem large and intractable. However, developing steps to address it can help reduce the issue and thus improve the nation’s health.
Works Cited
Aljabari, S, & Kadhim, Z. (2021). Common barriers to reporting medical errors. Scientific World Journal, 2021, 1-8.
IHI/NPSF Lucian Leape Institute & NORC at the University of Chicago. (2017). Americans’ experiences with medical errors and views on patient safety. Retrieved from IHI_NPSF_NORC_Patient_Safety_Survey_2017_Final_Report.pdf
Johns Hopkins Medicine. (2023, July 17). Report highlights public health impact of serious harms from diagnostic errors in U.S. Retrieved from Report Highlights Public Health Impact of Serious Harms From Diagnostic Error in U.S. (hopkinsmedicine.org)
Makary, M.A., & Daniel, M. (2016). Medical error - the third leading cause of death in the US. British Medical Journal, 353, 1-5.
Ofri, D. (2020). When we do harm: A doctor confronts medical error. Beacon Press.
Teitelbaum, J.B., & Wilensky, S.E. (2017). Essentials of health policy and law: Third edition. Jones and Bartlett Learning.
