Web Exclusive

Medical Errors, Hysteria, and Death
By Gerard J. Gianoli, MD

Medical errors are taken very seriously by the medical profession. It starts early in training at the Morbidity & Mortality (M&M) Conference. During M&M, each complication and death is presented before the entire department of students, physicians in training, and professors. The cases are scrutinized and criticized to see what could have been done better. No one likes to see complications or deaths—especially not physicians.

So how can medical errors have become the "third leading cause of death"—as trumpeted in a recent editorial in the BMJ? Where are those hundreds of thousands of casualties every year?

The actual number of patient deaths analyzed, over a period of 10 years was 35.

Shame on the BMJ for allowing this inflammatory, sensationalist article to be published and reported in the general news media without noting to the public that this was not a scientific study at all, but only an opinion piece. It presented no new research, and it was not peer-reviewed.

The paper simply states the average of three previously published studies and one paper that was never vetted through the peer review process—all published more than eight years ago. All four of these papers include a combined analysis of a grand total of only 35 actual patients, from which the authors extrapolate to 251,454 deaths due to medical errors in the United States every year. This is a highly dubious estimate.

In research, much depends on definitions. Consider the case of someone falling from a tree. In running to catch him, you trip over a stone. The person hits the ground and dies. Did your tripping over the stone cause that person's death, or was it the fall? According to the reasoning behind the BMJ article, the death was your fault.

When a patient was sent home from an emergency department in Dallas with Ebola, this was an error probably caused by EMR-related disruption. The patient later returned, and died. But he probably would have died even if this "systems" error had not occurred.

The one case presented in the BMJ article concerns a patient who died of complications from pericardiocentesis—inserting a needle into the sac around the heart. This procedure is risky. This was not a medical error, but a known complication that can occur even when everything is done perfectly by the most competent of physicians.

While proposing that iatrogenic deaths are underestimated, the authors never admit that death would be inevitable in many/most of these cases without medical intervention, and the margin of error in critically ill patients is often razor thin.

This article may turn out to be the "silicone breast implant hysteria" of our generation. In the 1980s and 1990s, there was much hype about silicone breast implants causing an epidemic of medical ills. The hysteria surrounding this was fueled by the FDA, the media, and plaintiffs' attorneys. As a result, many implants were removed without medical justification, undeserved money went into the hands of plaintiffs' attorneys, and a formerly successful major corporation (Dow Corning) was bankrupted. A moratorium was placed on the use of silicone, keeping it from cancer patients who desperately needed it for breast reconstruction. Finally, after a few decades, medical research has established beyond a reasonable doubt that the whole debacle was nonsense. Silicone is safe and is finally being used again.

What will be the result of this article? It will help sell more books for the authors and possibly help them get more grant funding, but I doubt it will result in fewer medical errors. In fact, it will likely serve only to increase already nightmarish bureaucratic burdens on medical professionals. The next time you see the doctor looking at the computer terminal instead of you, blame inflammatory opinion pieces like this one. Since system errors are the most common medical errors, there will almost certainly be more cases like the Dallas Ebola case.

Doctors and nurses are dedicated to improving outcomes from medical interventions and do not shy away from self-criticism. Self-serving, irresponsible sensationalism by armchair quarterbacks will only make the professionals' job more difficult.

— Gerard Gianoli, MD, FACS, specializes in neuro-otology and skull base surgery. He is in private practice at the Ear and Balance Institute, located in Covington, Louisiana, but is also a clinical associate professor in the departments of otolaryngology and pediatrics at Tulane University School of Medicine. He pioneered treatments for superior semicircular canal dehiscence and other vestibular disorders.