Survey Nearly One In Three Americans Report Medical Mistakes
According to a new Wolters Kluwer Health survey, 30 percent of all Americans report that either they or someone they know have experienced a medical mistake. More than one in five Americans report having been misdiagnosed by their doctor.
When asked why they believe most medical mistakes occur, more than one third of Americans (35 percent) cite miscommunication among hospital staff as the top reason. The next most common reasons cited include doctors and nurses being in a hurry (26 percent), staff being fatigued (14 percent) and hospitals experiencing staffing shortages (12 percent).
Nearly one in five Americans have delayed having a procedure for a day when they believed the doctor may have been more focused or rested (i.e. not scheduling on the weekends or late in the week).
Eighteen percent have asked a doctor/nurse to wash their hands. That’s a good idea because experts agree that medical personnel not washing their hands is the leading cause of hospital acquired infections which is the leading cause of serious medical error injuries and death. The statistics are
» every six minutes a U.S. hospital patient dies from a hospital-acquired infection.
» Each year 2 million American hospital patients acquire an infection during their stay.
» 52 percent of doctors do not wash their hands between patients.
The primary reason is that hospitals are focused on profits and regulators don’t hold them accountable. That’s according to the Departmental of Health and Human Services Office of Integrity which is a regulator. The unwillingness to address handwashing and other causes of medical errors rarely costs. Regulation usually focuses on financial fraud and not quality fraud. How big is the problem of quality fraud in this country? A study by the Department of Health and Human Services estimated that 1,600,000 hospitalized Medicare beneficiaries experienced harm from medical care every year. The harm was serious enough to cause 180,000 deaths per year which makes it the third leading cause of death in the U.S. after cancer and heart disease. An additional one in seven hospitalized Medicare patients experienced temporary problems, such as allergic reactions or injuries from falls(see full report (pdf). Only one out of six people in the U.S. receives Medicare or 47 million Medicare patients. That suggests that 10% of all medicare deaths are a result of a medical error.
Daniel Levinson, Director of the Office of the Inspector General(OIG) for the Department of Health and Human services said
" Obviously, this situation is unacceptable – and expensive, costing taxpayers more than $4 billion a year due to the need for additional treatment or longer hospitalizations (and even more if you add costs for follow-up care)."
“Government, which pays for a large portion of the nation’s medical care, must hold hospitals accountable for better care. New authorities granted by Congress further enable the Medicare program to use hospital performance as a basis for payment. Private insurers can join Medicare in finding effective ways to tie payment to quality.”
Unfortunately, the Medicare figures may be far too low and they doesn’t include deaths that occur among younger people who don’t have Medicare. In addition to the deaths, it’s been estimated that medical errors cause 6.1 million injuries both in and out of hospitals in the total population. Another study that included people of all ages found that one out of three patients admitted to a hospital was a victim of a medical error. Recent research indicates these estimates are too low. In fact, hospital reporting may capture as little as 14% of all medical errors. Furthermore, more accurate methods for detecting medical errors suggest the error rate may be ten times higher. In addition to the human costs, the economic costs have been estimated to be as high as a trillion dollars per year and may represent almost half of the US health care spending.
However, Daniel Levinson also found in a second study 66% of these cases of patient harm either went unnoticed or unreported. Even when people knew about the problems, hospitals didn’t change their behavior or learn from their experiences and most regulations went uncorrected and sanctions for bad behavior(providing low quality care) were few and far between. Under the new health care law, however, 2,211 hospitals were penalized for excessive readmissions which are associated with lower quality care.
Is it really true that half of our health care costs are wasted on quality fraud? The simplest way to make an estimate of the extent to which quality problems influence U.S. care is to compare U.S. health care costs to other countries with similar life-expectancies. The good news is that Americans life-expectancies have moved ahead of many other countries since the Affordable Health Care Act was implemented. For example, now our life-expectancies are greater than Cubans which wasn’t the case just a few years ago. The U.S. now ranks 50th in the world. Portugal ranks 49th. Per capita public and private health expenditures combined in Portugal are $2,199 USD while the United States spends $6,719 USD (click here for countries comparisons(click here (pdf). In other words, Portugal is paying 1/3 as much for their health care system and people are living the same amount of time. There are several reasons for the lower costs. First, insurance paperwork is much less. 1/3 of U.S. dollars go the paper while in Portugal there is very little paperwork. The other difference is that we have a very high quality, high tech well trained system that leads to lots of medical errors. Americans perceptions in the survey suggest that they believe time-pressure may have something to do with it. American physicians see more patients and have to spend more time on paperwork.
Despite high levels of concern about medical mistakes, Americans have confidence that technology to help reduce mistakes. The majority, 68 percent, believe that as the medical field continues to adopt new technologies, medical errors should decrease. However, the confidence of Americans may be unjustified unless that technology is improved.
Through the Health Care Reform law, President Obama attempted to reduce medical errors in a number of ways including the use of health information technology. For example, computerized medical records provide warnings and checks for medical errors. A recent review found that 92 percent of the recent articles on health information technology suggested that it works. There is also evidence that improvements in the health technology could lead to even greater reductions in medical errors. The President as part of the health care reform bill also created a Partnership for Patients program to encourage the reduction of medical errors. Similar plans have been effective in other countries.
Many physicians reported that current systems were unwieldly, not sufficiently user friendly and overly time-consuming. For example, technology can reduce medication errors by giving the physician alerts to possible drug interactions or side-effects associated with certain disease conditions. However, many physicians turn off the alerts because there number is too great, they find the alerts confusing, the information is redundant or there is no way to turn off alerts about things they already understand or are aware of. The problem goes back to the provisions in the health care law which allows each hospital to pay for a new medical technology system. Both physicians who meaningfully use such systems and hospital receive financial assistant to help with the implementation. Why did the health care law decide to do that when the VA already had a medical record system in place? Well the software for the VA system is unusual. However, it would cost less to simply rewrite the new system in a different computer language and then provide a customizable system to hospitals. This would help many hospitals that lack the expertise or training in making decisions about highly customizable and complex systems, it would also avoid the duplication of effort of having each hospital implement it’s own system and would have greatly reduced the costs of implementing unique systems at every hospital. Hospitals are not in the business of making such complex technology systems. Chances are they will make mistakes and pay too much.
The main reason seems to have been that some senators feared that a national system that could be used to spy on everyone’s health care records. However, many European countries have nationalized health systems that have other advantages. First, any physician can access your medical records which could save your life if for example you were injured on a vacation. Second, it allows the country to use the data from such systems to better understand health problems and conduct research on disease.
So why do politicians ignore the issue? Perhaps Democrats fear that talk of medical errors will increase public concern over national health care. Perhaps Republicans fear that solutions will lead to bigger government or more expensive. Therefore, no alarm bells are sounding and no major changes are being implemented to improve quality. The health care bill primarily addressed health insurance reform. However, the reality is that health care quality is a far more important and pressing problem than financial issues or even lack of health insurance. Estimates of the number who die from lack of health insurance are far lower than those who die from medical errors. It’s estimated that 25,000 to 50,000 lives are lost each year in the U.S. due to lack of health insurance. When you combine the 50,000 number with the number of medical errors, poor quality and nonexistent care may be the leading cause of the death in the United States! Currently, tobacco use is believed to be the leading cause of death in the U.S Experts believe that as many as 465,000 tobacco-related deaths occur each year.
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