Why Patient Harm Is One of the Leading Causes of Death in America

Why Patient Harm Is One of the Leading Causes of Death in America


by Marshall Allen

ProPublica, Sept. 18, 2012, 3:30


Dr. Makary: The debates about health care reform frustrated me because our complex system of health care and culture of medicine were reduced to simple sound bites. People pushed the idea that changing the payment system would solve the problems. But I observed every day what I see to be the main driver of health care costs: the massive variation in the quality of care – across the country, within cities, and even within good hospitals.



I saw this variation in quality and the alarmingly high error rates, and it hit me that unless we can be open and honest that up to 30 percent of health care is unnecessary, and that 1 in 4 hospital patients are harmed by a mistake, then we’re just going to be continuing to beat our heads against a wall trying to pay for a broken health care system, instead of fixing it.



PP: What type of problems did you observe?



Dr. Makary: I saw cases where a patient was not told about a minimally invasive way of doing a particular surgery because of physician preference or training, and the doctor would just hope that he wouldn’t find out. If that patient were empowered by talking to the right people, or by doing his own research, he would be able to get superior care. It’s no wonder that about a third of all second opinions about surgery yield different opinions.



Medical mistakes are the fifth- or sixth-most common cause of death in the United States, depending on the measure. But few people look at it that way. That’s because we haven’t been honest about it in the past. And we have hospitals that fire doctors and nurses when they speak up.There was a nurse recently fired in Florida for complaining about a doctor doing unnecessary procedures, a report substantiated by an internal report gotten by The New York Times. A cardiologist in Wisconsin was fired for pointing out that EKGs were misread more than 25 percent of the time. We need to change the culture of medicine.



There is New England Journal of Medicine-level data that suggests that almost half of care is not compliant with the evidence. In my own field of cancer surgery, I have seen patients treated in ways that are not supported with evidence.In the case of radiation treatment for pancreatic cancer, there is evidence from large cooperatives overseas that there is a harm to radiation. Many studies show no evidence of benefit to radiation, and yet patients are routinely offered radiation treatment and have the expectation that it’s going to help them do better. I see PET scans offered routinely – an expensive test – that has never been shown to benefit diagnosing pancreatic cancer.


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http://www.propublica.org/article/qa-marty-makary-m.d.-author-of-unaccountable