Is the “See one, do one, teach one” culture still working?

Dr. Martin Makary, M.D., and Dr. Michael Daniel, M.D., researchers at John Hopkins University School of Medicine, published a study in the BMJ this week citing medical errors as the third leading cause of death in the U.S. They suggest there are 251,454 deaths due to medical errors in the United States alone. According to Center for Disease Control (CDC) prevention data, only heart disease and cancers are more lethal.

The study, published as an open letter to CDC’s Director Thomas Frieden, stresses the inaccurate information captured by the CDC. The CDC tracks various deaths such as injury, disease, etc, and excludes medical errors as a valid cause. Dr. Makary stated, “the medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used”. This system was first adopted in 1949 and uses the International Classification of Diseases (ICD) codes to tally causes of death. Dr. Makary suggests this system needs to be updated to better code for medical errors.

The authors based their study on a meta-analysis of  death rate data from 2000 to 2008. They compared this with hospital admission rates and found that based on 35,416,020 hospital admissions, 251,454 deaths stemmed from medical error. This translates into 9.5 % of all deaths each year in the U.S. Certain changes in surgical practice, like the WHO checklist, have helped to reduce surgical errors, however, this study is important for several reasons.

First, as Dr. Makary suggests, it highlights a real need for better data on patient outcomes as well as the entire clinical process. As more and more hospitals transition to EMRs, it is important to make data input simply for physicians. Second, we agree with Dr. Makarys’ view that medical errors should not be regarded as the result of bad doctors. Reporting these errors should not be addressed by punishment or legal action. Instead, through accurate and complete documentation of the clinical journey, the dataset should be used for better research and the introduction of an educational feedback loop in order to prevent such errors from happening in the future. Finally, more and more funding should be allocated to evaluating hospital systems to reduce medical errors.
Certainly, technology can have a role to play here. However, it all starts with us acknowledging the importance of this problem. On behalf of Touch Surgery, we would like to thank Dr. Makary and his team for their work to highlight this issue.