By Brian Carnell

Friday, April 12, 2002

In a book review of Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science, Ivan Oransky notes that medical errors are a serious problem. Unfortunately Oransky repeats claims that vastly overestimate the extent of the problem. Oransky writes,

Three years ago, the National Institute of Medicine estimated that medical mistakes kill between 44,000 and 98,000 people per year. If that's true, it means medical errors kill more people each year than car accidents, breast cancer or AIDS . . .

While some researchers have successfully poked some holes in the estimates of the number of patients killed by errors, the real effort should be aimed at ways to change the practice of medicine to make it safer.

Lets back up there. If some researchers have poked holes in the claim that 44,000 to 98,000 people are killed every year by medical mistakes, then what exactly is the extent of the problem? Just what sort of holes have others poked in the National Institute of Medicine's figures?

Well, as this site pointed out last August, Rodney Hayward and Timothy Hofer pointed out enormous holes in the NIM figures in an analysis published in the Journal of the American Medical Association. Their look at the NIM study suggested that the actual number of deaths from medical errors is in the range of 5,000 to 15,000.

The basic problem is that doctors do not agree on what constitutes a medical error. What Hayward and Hofer found is that if you show a patient's case history to enough doctors, you'll inevitably find someone who disagrees with the treatment regiment that the patient received.

So the number of medical errors depends a lot on how such errors are measured. If the consensus of a panel of medical experts is used, then the number of medical errors is relatively small. If a medical error is considered to be any case history where even just one doctor on a panel says it was a medical error, then the result is the high numbers seen in the NIM study.

If the accurate figure is 15,000 rather than 98,000, then far more precaution needs to be taken when introducing computerized diagnostic systems to ensure they really are going to lead to a reduction in medical errors.

Source:

Robo-docs. Ivan Oransky, M.D., Salon.Com, April 9, 2002.

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