Healthcare has become a hotly debated topic in recent years, as Obamacare has made itself the center of conversation. What is often overlooked, however, is the appalling rate of medical malpractice in the U.S. medical system.
Speaking as the chairman of the Senate Subcommittee on Primary Health and Aging, Vermont Senator and Democratic presidential candidate, Bernie Sanders states: “Medical harm is a major cause of suffering, disability and death–as well as a major financial cost to our nation… this is a problem that has not received anywhere near the attention that it deserves and today I hope that we can focus a spotlight on this matter of such grave consequence.”
These are heavy words to describe a problem most people are probably not aware of. Just how bad is it? In 2014, Dr. John T. James released the “Journal of Patient Safety,” which found over 440,000 Americans are dying annually from preventable hospital errors. This makes medical malpractice the third largest cause of death in the U.S., following heart disease and cancer.
With such a high number of preventable injuries and mortalities directly attributable to the very institutions charged with relieving society of them, the lack of public outcry, let alone conversation, is alarming.
The Truth Behind Malpractice
What types of errors transpire that result in a casualty count roughly equal to the population of Miami? An associate professor at Johns Hopkins University School of Medicine, David E. Newman-Toker, posits that diagnostic errors, which occur between 5 to 15 percent of the time, account for not only the largest percent of U.S. malpractice claims, but also contribute to the most severe patient harm.
The Journal of Patient Safety study states the five major causes of PAEs (preventable adverse effects) in hospitals include:
- Errors of commission, caused by mistaken action, such as accidentally nicking an intestine during gallbladder surgery, leading to gallbladder infection
- Errors of omission, defined by a lack of obviously necessary action, such as a failure to prescribe essential medication or treatment
- Errors of communication, exemplified by a physician failing to provide crucial information to her patient or to another physician
- Errors of context, exemplified by failure to take into account unique constraints in a patient’s life that could bear on successful, postdischarge treatment
- Diagnostic errors, which result in delayed, improper, or ineffective treatment, and which the study states may be considered separately as a cause of PAEs in hospitals.
Diagnostic errors are hard to track and can actually serve as the impetus for errors of commission and omission. Imagine being told that you need surgery for a tumor in your neck, only to find out post-surgery that a case of swollen lymph nodes due to mononucleosis was misdiagnosed–and that you never actually had a tumor in the first place.
Overdiagnosis vs Misdiagnosis
Dr. James’ study also mentions over-diagnosis, citing Dr. H. Gilbert Welch’s book Over-diagnosed: Making People Sick in the Pursuit of Health, which concludes that overdiagnosis constitutes one of the biggest problems in modern medicine.
Newman-Toker’s John’s Hopkins study establishes as much, stating that with an estimated 80,000 to 160,000 patients severely affected per year by them, “diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States.” He estimates in a separate study that between 40,000 and 80,000 of these cases of misdiagnosis will prove lethal.
With all of this information at hand, what is being done to curtail this epidemic? Considering human error and lack of responsibility is to blame for the national pickle our healthcare system is in, some are calling for the use of technology to permanently tackle the problem.
Will Technology Help or Burden the Issue?
The U.S. Federal Government passed the HITECH Act in 2009, a piece of legislation that grants financial incentives to hospitals and healthcare providers that switch to an Electronic Health Records (EHR) system (and, it’s worth mentioning, financially penalizes those who do not adopt it).
This connected network of computers has been designed to keep accurate records, streamline the hospital experience, and to reduce instances of harm in the healthcare system via more effective patient diagnoses, reduction of medical errors, more accurate and reliable prescribing, and overall provision of safer care.
Because of how fresh the new EHR system is, it’s hard to provide definitive figures on harm reduction, but some sources such as the AHRQ, are currently supporting and citing research postulating that EHRs currently being used to identify instances of misdiagnosis can help curb misdiagnosis in the future, and that other computerized systems might be able to reduce likelihood of medication error by half, potentially avoiding 17 million such incidents per year.
HealthIT.gov presents optimistic figures indicating that EHRs can and may improve diagnostics and patient outcomes as well, and HealthcareITNews.com ran an article claiming that “the widespread adoption of EHRs will likely reduce the deaths and injuries that can result from misdiagnosis because many are now equipped with clinical decision support (CDS) software to help physicians pinpoint the correct diagnosis.”
While these reports are encouraging, they are still mired in hypothetical “can” and “may” language, and are supported and presented by entities that benefit in one way or another from the continued adoption and use of EHR systems. They’re further tarnished by admission from both a 2014 report from the Institute of Medicine and actual EHR vendors themselves, that these systems can and do cause medical errors.
Arguing Against EHR systems
Surprisingly, the biggest opposition to EHR implementation is coming from healthcare providers themselves, including the current president of the American Medical Association, Steven Stack. They’ve maintained that a broken system has been replaced with another broken system.
“Instead of improving patient encounters, the tech is slowing physicians down …the programs themselves aren’t designed to accommodate the needs of the user, the physicians and allied health personnel, but rather the data-gathering interests of the CMS (Centers for Medicare & Medicaid Services),” says Stack.
Additional questions surrounding the security of the EHR system have arisen, especially now that individual healthcare providers and their staff (regardless of their level of technological literacy) are the ones responsible for complying with HIPAA’s cybersecurity standards. All it takes is a simple breach in protocol by an unassuming nurse or doctor, such as unknowingly plugging an infected USB stick into a networked computer, or downloading sensitive data to a pair of unencrypted laptops, to disrupt the system.
This profit-at-all-cost mentality has produced an EHR system that, though lucrative for insurance companies and the producers of the machines, suffers from pitfalls inherent in its architecture, and, instead of solving the problems that it was designed to alleviate, has created entirely new ones while simultaneously exacerbating those that have contributed to the third highest cause of death in the U.S.
The sliver of good news is that the EHR system is still young, and truly does stand a chance at someday making a dent in the number of preventable deaths caused by medical errors–especially if the public finally begins to speak up.
Until then, the most effective way to protect yourself from misdiagnosis is to take responsibility for your own medical destiny, and become an active participant in your own healthcare. As Evan Falchuk, the Vice Chairman of Best Doctors, Inc., writes: “Ask questions, know your family (and personal) history, and make sure you keep asking questions until you’re satisfied you are comfortable with what you are being told.”
Being an involved and engaged patient will help your medical team not overlook important facts and ultimately help avoid misdiagnosis.