Doctor’s Tip: Avoid being a victim of the No. 3 cause of death
Most people who go into medicine do so because they want to help others. And all doctors are aware of the part of the Hippocratic oath that says first, do no harm. However, the medical field has a dirty little secret: More than 250,000 deaths a year in the U.S. are caused by mistakes by the American health-care system, making this the third leading cause of death, after No. 1 heart disease and No. 2 cancer.
In his book “How Not to Die,” Dr. Michael Greger devotes a chapter to how not to die from iatrogenic causes, iatrogenic referring to doctor-caused. Here are the pertinent facts:
• Side effects from medications given in hospitals kill approximately 106,000 Americans every year, and another 199,000 deaths occur from deaths from prescription drugs prescribed on an outpatient basis (this figure does not include deaths from prescription narcotics or intentional overdoses).
• At least 7,000 people die in hospitals every year from being given the wrong medication by mistake.
• Some 20,000 patients die annually from other hospital errors.
• Hospital-acquired infections result in 99,000 deaths a year. Given this, it’s unconscionable that care workers are only 50 percent compliant with hand-washing recommendations, with studies showing that doctors are the worst offenders.
• Twelve thousand patients die every year from complications from operations that were unnecessary in the first place, let alone patients who die from complications from operations deemed “necessary.”
• Radiation from studies such as CT scans and nuclear cardiac stress tests is estimated to cause thousands of cancer deaths every year. Often these studies are unnecessary, and patients aren’t informed about the risks of radiation or about safer alternatives.
• Diagnostic errors contribute to 10 percent of iatrogenic patient deaths.
• Forty-five percent of patients don’t receive the recommended treatment for their condition. For example, many studies show that when patients are discharged from hospitals after heart attacks, a large percentage don’t receive all the guideline-recommended treatments, whether their caregivers were cardiologists or primary care doctors.
• Often when primary care physicians see patients for follow-up visits after discharge from the hospital, they don’t have the documents such as discharge summaries needed for appropriate continuity of care. A 2009 study showed that 30 percent of hospitalized Medicare patients were readmitted within 30 days.
An eye-opening, well-written book worth reading is “How Doctors Think,” by Jerome Groopman, a hematologist and oncologist. One of the stories in it is about a patient named Anne, who at age 20 started having severe abdominal cramps, nausea and diarrhea whenever she ate. This led to significant weight loss and malnutrition, including an impaired immune system, and she came close to dying.
She saw multiple doctors over the years, including specialists, and underwent a multitude of tests. Eventually she was diagnosed with anorexia and bulimia and was sent to psychiatrists. Finally, after years of this, she saw a specialist who sat down with her and took the time to listen to her complete story (good medicine is not always about expensive tests) and diagnosed her celiac sprue, which was confirmed by appropriate tests.
He told her to go on a gluten-free diet, and soon she was well and has remained so.
Personally, I have had one negative encounter with the medical system: When I was a freshman at Oberlin College I developed low abdominal pain. I went to the college physician (students called him “Max the Ax”) who examined me and told me I was constipated and to go back to my dorm room and take an enema, which I did.
The next day I felt worse and late in the afternoon went back to the student health clinic. I told the nurse I was worse, but she told me the clinic was closing for the day and to come back the next morning. Luckily, I had the presence of mind to see a private surgeon in town, and within an hour I was on the operating table with a ruptured appendix, a condition that people die from to this day.
We all have had or know people who have had experiences like this. Having discussions like this is not doctor-bashing (I am proud to be a physician and feel fortunate to be in a field where I can help people). However, we doctors could, should and must take ownership of these problems and make the necessary changes so that medical mistakes are maybe the 100th cause of death instead of the third.
Obamacare includes incentives to avoid medical errors. A few hospitals in the country have taken aggressive steps in this direction, with good results. And all hospitals have taken at least some steps to correct iatrogenic deaths, such as encouraging hand-washing and developing systems to prevent surgeons from operating on the wrong extremity.
Some medical system analysts think that medicine should be run more like the airlines, with checklists. This shouldn’t be that hard to institute, with modern technology such as computers. But in medicine, there is always a lot of inertia due to a desire to maintain the status quo, even if the status quo involves tens of thousands of patient deaths.
One option, of course, is to limit our contact with the medical system by taking better care of ourselves, with daily exercise and optimal diet.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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