To Err is Human, But Can We Learn From Our Mistakes?
A recent study asked the question: How often do mistakes happen in hospitalized adults who end up being transferred to the intensive care unit or who die in the hospital, and what are the causes of the errors?
This is obviously an important question, because we believe that if we are sick enough to need a hospital, then being there should help us get better.
But this isn’t always the case. In fact, in 1999, just as I was finishing medical school and about to start my residency program in Internal Medicine, the U.S Institute of Medicine came out with a then-famous landmark report entitled To Err Is Human: Building a Safer Health System.
At the time, this report dramatically increased awareness of the high prevalence of medical errors. Based upon analysis of multiple studies available at that time, the authors of the report estimated that 44,000 to 98,000 people died each year as a result of preventable medical errors.
At the time, this was earth-shattering news: it suggested that 2-4% of all deaths in the United States were caused by medical errors.
In response to that report, dozens and dozens of initiatives and programs were created to address this isssue.
So how have we done?
Fast forward 25 years: in January 2024, JAMA Internal Medicine published a report on the modern incidence of medical errors.
This was a retrospective study conducted at 29 academic medical centers in the US in a random sample of adults who had been hospitalized from January 1 to December 31, 2019 with general medical conditions and who were transferred to an ICU, died, or both.
In this group of 2428 patient records, a missed or delayed diagnosis took place in 23% of them, with 17% of these errors causing temporary or permanent harm to patients.
Two main categories of potential errors were highlighted by the research study.
The first category included problems related to testing, such as choosing the correct test, ordering the test in a timely fashion, or correctly interpreting results.
The other main category of errors were problems with assessment, such as recognizing complications in a timely manner or appropriately re-considering the initial diagnosis in light of new testing and then considering other diagnoses.
Now, it is important to highlight that this was a selected sample of the sickest patients in the hospital. Some of these patients may have had poor outcomes regardless of the errors.
So what does this mean? Of course, one lesson is that even in the best hospitals, with the best doctors, mistakes can happen.
But I think the bigger lesson is that bad stuff can happen when you are sick enough to be hospitalized. Sometimes the condition for which you are hospitalized can kill you, or cause serious or permanent harm. Sometimes your condition can be so complicated that it’s hard to diagnose exactly what is happening, and therefore it's harder to treat.
So what can we do about this?
Don’t depend on the medical system to save you when you need it; that’s the wrong way. Instead, spend your time and focus your attention on being as healthy as you can be. If you work to improve your own health, you will dramatically reduce the chance that you will need to be admitted to the hospital, where we now know that even after 25 years of work, errors still frequently happen.
At Wisconsin Cardiology Associates, we counsel our patients on ways to improve their lifestyles to help them achieve and sustain better health throughout their lives.
Our clinic is open and we are accepting new patients
