WhiteCoat

Safety of Medical Care in US

Remember that statistic from the 1999 Institute of Medicine report that trial lawyers like to throw in everyone’s face about how “up to 98,000 people in the US die each year due to medical mistakes”? It’s like TWO 737 jetliners crashing every day … and we’re doing nothing about it.

So today a news story was sent to my inbox that included Saudi Arabian Ministry of Health statistics on medical malpractice. The report shows that there were 1,356 cases of malpractice in Saudi Arabia in 2009 and that “129 people died from medical mistakes in 2009.” Of course, the 129 number seemed quite low to me given the 98,000 number that is constantly cited in the press. Maybe Saudi Arabia’s population is just smaller than I thought.

Nope. Saudi Arabia has a population of roughly 26 million – about 1/12 of the 310 million people in the United States.  Multiply those 129 Saudi Arabian deaths by 12 and the population adjusted death rate from medical mistakes in Saudi Arabia is 1,548 — versus 98,000 for the United States.

Look at it another way. Divide 98,000 deaths from medical mistakes in the United States by a population of 310 million and you get about 316 deaths per million population in the United States due to medical mistakes.
Divide 129 deaths from medical mistakes in Saudi Arabia by 26 million population and you get about 5 deaths per million population in Saudia Arabia from medical mistakes.
316 deaths per million in the US versus 5 deaths per million in Saudi Arabia.

Is medical care in the United States that much worse than in Saudi Arabia — even without the benefit of safety agencies such as the Joint Commission and HospitalCompare.gov?
Or do unrealistic requirements from “safety” organizations such as the Joint Commission and “quality measures” from our government actually cause more deaths from medical mistakes?
Or are the Institute of Medicine’s numbers so far off that they shouldn’t be believed?

I did a little more searching.

This parliamentary paper from the United Kingdom pegs deaths due to medical “incidents” at about 3,500 per year in England. In a country of 52 million people, that averages out to about 67 deaths per million population – still about one fifth of the alleged United States numbers.

Then I found a Canadian study showing that the range of deaths from “medical misadventures” in various industrialized countries ranges from 1 per million population to 10 per million population. The US is in the middle of the pack at about 6 deaths per million population per year – which equates to about 1,860 deaths per year from “medical misadventures” in the United States.

1,860 deaths versus 98,000 deaths

Why are the numbers in that IOM paper such outliers?

And why do the trial attorneys keep citing it as gospel?

22 Responses to “Safety of Medical Care in US”

  1. throckmorton says:

    I dont think statistics are attorneys strong points. (Is stats even a requirement for law school?)I have had numerous opportunities to try to explain to them what constitutes true positives, true negatives, and predictive ability and they just dont seem to get it. We recently had an attorney present a research paper at a deposition where he was trying to sue the medical center and when we looked at the paper, the data analysis in it actually refuted his and the paper’s claim!

  2. Matt says:

    Are tort reformers really arguing about the statistics of the other side? These are the people who claim dramatic drops in filings the year after their “reform” as “proof” it works. Given that, I’m pretty sure physicians are in no position to criticize someone else’s understanding, or lack thereof, of statistics.

    Although I’m not sure why you are criticizing attorneys for the IOM study. It’s not like they commissioned it. Like your friends in the tobacco and insurance industry do the tort reform stats!

    • Dr. J says:

      Matt: I think rationale physicians, regardless of their position on tort reform can reasonably question studies when multiple studies reveal discrepant results. This is true for pure clinical issues (like TPA in stroke), and for administrative or database studies like death due to error.
      I realize that the role of a lawyer in an adversarial system is to find support for the position of their client, and I think it is obvious why the more dramatic statistic is the one presented. That is a totally separate issue from analyzing and dissecting these various studies either to determine what the reliable data is, or to determine how to develop a new study capable of answering the question.
      For people and physicians with less interest in tort reform this is not an issue about statistics from a ‘side’, rather it is a set of sobering results that can potentially help physicians and patients who are on the same side (not involved in lawsuits) to improve care and outcomes.
      I know you and Whitecoat have this long standing tort reform argument, the character of which sometimes resembles a married couple fighting about which mother-in-law makes better turkey stuffing. I enjoy the banter between you two. In the end I don’t think it can be distilled to a pure legal issue though…
      Dr. J

      • Matt says:

        Again, lawyers didn’t develop this statistic. The IOM did. It’s not used in any trials, because it’s not actually evidence.

        So vilifying lawyers because of it makes little sense.

        I’m merely pointing out the irony of a physician questioning statistics when they’re all too willing to swallow any number that suits their preconceived notions, and then they condemn the other side for doing the same.

        And it’s clearly my mother.

      • WhiteCoat says:

        This ATLA mouthpiece Joanne Doroshow just quoted the statistic again over on HuffPo.
        http://www.huffingtonpost.com/joanne-doroshow/a-real-medical-liability-_b_821066.html

        I have an interest in tort reform only to the extent that it affects the availability of medical care to our patients. I get paid hourly, so whether it is full or empty, whether it is all commercial insurance or all Medicaid, I get paid the same.

        Say we do nothing with tort reform. Defensive medicine continues, less trust between doctors and patients, the system gets worse. I still have a job. I’ll probably end up ordering more low-yield tests to make sure that nothing gets missed. I’m not going to risk my life savings because I didn’t order a test.

        When I cite these news articles and give commentary, it is a perspective “from the trenches.” I have experience from an administrative standpoint, from a practice management standpoint, from a physician’s standpoint, and tangentially from a medical-legal standpoint.

        When I argue a point, it’s not just me venting. I have discussed and continue to discuss the issues with other physicians, residents, administrators, and attorneys. I have made many presentations about these issues to bar associations. They have unvaryingly been well-received.

        I keep throwing out ideas for change because repetition improves recall. I want people to recall my thoughts when they see another hospital close or when they think they’re getting a great deal with Medicaid “insurance.”

        Maybe … hopefully … some day these ideas will percolate up to someone who has the ability to affect change.

        As for the married couple bickering – Matt wins that fight. Don’t even get me started on the “mama” jokes. Besides, I fricking hate stuffing.

        Oh, and notice that Matt still hasn’t defined “innuendo” or “strawman”, have you, Matt?

        Nyaah.

      • Matt says:

        “Say we do nothing with tort reform. Defensive medicine continues, less trust between doctors and patients, the system gets worse.”

        Say we do what you propose with tort reform. Oh wait, we already have. For decades. It’s never worked. Never solved the problems you claim it will. You celebrate Texas’ tort reform. Any less defensive medicine? Nope. Any better relationship between physicians and patients? No way of telling. Any better access in rural areas? Nope. At some point facts have to be a part of your conclusions, unless you’re just an insurance/tobacco shill.

        All we get from you is hyperbolic nonsense like this: “I’m not going to risk my life savings because I didn’t order a test.”

        The “system” isn’t getting worse, because you can’t define better or worse. When people say single payer systems in other countries are better, you point to a whole host of statistics that refute that.

        Everyone with any sense knows that nothing changes with defensive medicine or patient-physician relationships unless the payment model changes. That’s it. Anyone who still thinks tort reform will change that after 40 years of trying it and it not working is again, probably a shill for the tobacco/insurance industry or frankly just a fool.

        As for access, the poor rural areas will always be underserved, and wealthy urban ones always overserved. Always have, despite whatever “reform” you’ve gotten passed, and always will. Your mouthing about access is just empty rhetoric that physicians use on any issue they don’t like. It’s never been borne out by the evidence.

  3. Joan says:

    Is it adjusted for how many doctor’s visits/surgeries/whatever? Because if only, say, 31 million or so of the 310 million people in Saudi Arabia actually have access to health care, that would skew the numbers a bit.

  4. ER Murse says:

    Didn’t you know that 78.3 percent of statistics are made up on the spot?

  5. paul says:

    wc- another nyc ed bites the dust?

    the news is buzzing with the possibility of LICH closing in brooklyn. have already received 2 inquiries about positions at our hospital from docs scrambling to avoid being unemployed.

    good thing we’re not in the same patient catchment area… yet

  6. David says:

    Why? Same reason the AMA claims a gun kept in the home is 22 times more likely to be used to kill a family member or a friend than an intruder. Because it supports their cause.

  7. throckmorton says:

    Hmm. If the care is Saudi is so much better, why does the King of Saudi Arabia and his family get their medical care in Minnesota and Cleveland?

    • There is good evidence that we can do better at error prevention even if the IOM statistics are not based on data and techniques equivalent to that generating the data from other countries. The books and articles written by Atul Gawande help point this out, and I found them well written and persuasive.

      If the patient from elsewhere is treated in the USA then there will be neither a malpractice suit nor a medical error in the country of origin. If we replaced our current healthcare system with medical transportation to and treatment in Saudi Arabia there would be a much lower number of medical errors attributed to care in the USA. If someone dies at home because of lack of access to care it is not counted as malpractice or as a death caused by medical care errors.

      Sometimes I think the error can be attributed to choices made by the patient to pursue unscientific quackery. I recall that about 50% of the lives saved by medical interventions are those saved by vaccines, yet in spite of the scientific evidence many refuse them. Of the approximately 25,000 who die in the USA from the flu each year I suspect many could have been saved by vaccination. People sometimes seek out ineffective quack treatments such as chiropractic, acupuncture, homeopathy, herbals, etc. instead of science based reliable effective medical treatment. Sometimes physicians themselves recommend unscientific treatment. Sometimes people have profound suffering that we cannot explain or relieve and they seek out some complementary remedy or alternative practice out of desperation and hope.

  8. Hueydoc says:

    As with all studies, the main questions are
    Who says so?
    Who are they?
    How do they know?
    and most importantly,
    Who funded this study ?

  9. Doc99 says:

    From a colleague …

    “… most of the mistakes in the IOM report were nursing errors, not physician errors. What is the nature of nursing care in SA? Do they have nursing homes there? If no nursing homes, then of course no nursing-home-generated mistakes. Likewise, what are the characteristics of their hospitals, and their outpatient clinics or medical offices?

    If the care was so much better in SA, then why do the King and his princes come to the US for their care?

    The fault with the statistics is that we have allowed the wrong denominator to be chosen. Instead of number of mistakes per population, we should be talking about the number of mistakes divided by the total number of medical decisions. For example, the airline industry and the highway transportation safety board both talk about deaths per mile traveled.

    Put another way, is skateboarding a safer mode of transportation than autos or planes because the total number of deaths is so much less? Is Saudi Arabian medicine safer than American medicine because the total number of deaths is less? ”

    Statistics are like bikinis – what they reveal is suggestive; what they conceal is vital.

  10. Ken says:

    The number comes from poorly done study. It’s nothing more than one groups over estimated guessing. And that group had plenty of motivation to exaggerate. Crap data in = crap data out.

    http://www.m.webmd.com/a-to-z-guides/news/20000705/report-of-deaths-from-medical-errors-called-exaggerated

    So many things get repeated until it’s taken for truth but if you go back to the source it’s often based on very limited and uncompelling data.

  11. [...] and Stripes] Why is the most widely cited number of medical-misadventure deaths such an outlier? [White Coat; more here, here, [...]

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