"Insisting on perfect safety is for people who don't have the balls to live in the real world." - Mary Shafer, NASA Ames Dryden.
Avoidable medical errors added $19.5 billion to the nation's health care bill in 2008, according to a claims-based study conducted by Millman, Inc. on behalf of the Society of Actuaries (SOA)
The quality of the literature I read on health care policy tends to be pretty poor, lacking both context and understanding. Occasionally, something comes out that is so bone-jarringly terrible that I don't know whether to laugh or cry. The article "the top ten medical errors" is as bad as it gets. Unfortunately, layman and politicians read the headline, and immediately assume that they can "save" the 19 billion dollars by stopping those stupid doctors from making those errors as if they were equivalent to misspellings or addition mistakes.
"Medical error" is not defined as a "deviation from correctness" but instead as "preventable adverse effect of care", a not so subtle semantic difference from common usage. "Preventable" does not mean someone did something wrong, and does not comment about how easy the problem is to avoid, but the implication is that the "error' is something that can be easily corrected, which is simply not true.
Even a cursory investigation into this "list", reveals that these "errors" are well recognized, extensively investigated, and already the target of intensive effort. This report, generated by actuaries, implies that surgeons can say " gee, we had another post surgical infection, let's wash our hands this time", or "darn, that pacemaker failed, we should use one with a new battery for the next patient". The reality is far more complex. Like any other quality assurance program, the cost and difficulty of reducing the last marginal error rises exponentially. These reports, written by people who have never done, or even seen, an intricate surgery, cannot possibly reflect the herculean efforts already expended to address some of these problems.
For instance, the first "error" is pressure ulcers. Such ulcers generally occur in nursing home patients confined to their beds. Yes, these ulcers are preventable in theory, but require intensive and constant nursing care, which is expensive. It is ironic that is is listed first, as the doctors themselves have little influence on this complication. The cost of the extra nurses required to dramatically reduce this complication may well be greater than the money saved.
The second "error", post operative infections,is a problem that has been intensively investigated and addressed by surgeons for over 100 years. Some recent initiatives using "checklists" and various standardized procedures have been instituted with some mixed results, but the fact remains there is no simple, reliable way to cut infections substantially. Simply placing "surgical infections" on the list without context is something only an actuary could do.
Going down the list, virtually every one of these "errors" defies easy solution. Such realities are of little concern to various advocacy groups with political agendas who will use these articles to say "we can say money by avoiding errors". Calling them "medical errors" discounts the practical difficulties of addressing them. "Error" implies "fixable",which is at best misleading, and at worst outright deception.
Once the phrase "19 billion dollars in medical errors" gets into the popular press it can take on a life of its own, becoming a mantra that if repeated often enough becomes justification for redirecting money and setting policy, sort of like Obamacare.
Avoidable medical errors added $19.5 billion to the nation's health care bill in 2008, according to a claims-based study conducted by Millman, Inc. on behalf of the Society of Actuaries (SOA)
The quality of the literature I read on health care policy tends to be pretty poor, lacking both context and understanding. Occasionally, something comes out that is so bone-jarringly terrible that I don't know whether to laugh or cry. The article "the top ten medical errors" is as bad as it gets. Unfortunately, layman and politicians read the headline, and immediately assume that they can "save" the 19 billion dollars by stopping those stupid doctors from making those errors as if they were equivalent to misspellings or addition mistakes.
"Medical error" is not defined as a "deviation from correctness" but instead as "preventable adverse effect of care", a not so subtle semantic difference from common usage. "Preventable" does not mean someone did something wrong, and does not comment about how easy the problem is to avoid, but the implication is that the "error' is something that can be easily corrected, which is simply not true.
Even a cursory investigation into this "list", reveals that these "errors" are well recognized, extensively investigated, and already the target of intensive effort. This report, generated by actuaries, implies that surgeons can say " gee, we had another post surgical infection, let's wash our hands this time", or "darn, that pacemaker failed, we should use one with a new battery for the next patient". The reality is far more complex. Like any other quality assurance program, the cost and difficulty of reducing the last marginal error rises exponentially. These reports, written by people who have never done, or even seen, an intricate surgery, cannot possibly reflect the herculean efforts already expended to address some of these problems.
For instance, the first "error" is pressure ulcers. Such ulcers generally occur in nursing home patients confined to their beds. Yes, these ulcers are preventable in theory, but require intensive and constant nursing care, which is expensive. It is ironic that is is listed first, as the doctors themselves have little influence on this complication. The cost of the extra nurses required to dramatically reduce this complication may well be greater than the money saved.
The second "error", post operative infections,is a problem that has been intensively investigated and addressed by surgeons for over 100 years. Some recent initiatives using "checklists" and various standardized procedures have been instituted with some mixed results, but the fact remains there is no simple, reliable way to cut infections substantially. Simply placing "surgical infections" on the list without context is something only an actuary could do.
Going down the list, virtually every one of these "errors" defies easy solution. Such realities are of little concern to various advocacy groups with political agendas who will use these articles to say "we can say money by avoiding errors". Calling them "medical errors" discounts the practical difficulties of addressing them. "Error" implies "fixable",which is at best misleading, and at worst outright deception.
Once the phrase "19 billion dollars in medical errors" gets into the popular press it can take on a life of its own, becoming a mantra that if repeated often enough becomes justification for redirecting money and setting policy, sort of like Obamacare.
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