Addressing the Third Leading Cause of Death in the United States

This article was originally posted in our April 2017 Newsletter, by Doug Smith, CEO, Medical Educator

What is the third leading cause of death in the US. Is it cardiovascular disease or cancer? No, those are numbers 1 and 2 respectively killing 614,348 and 591,699 in 2014 per the CDC. Is it COPD or accidents (unintentional injuries)? No, these would be number 4 and 5 respectively killing 147,101, and 136,053 respectively. How about stroke, Alzheimer’s and diabetes? No again, being 6, 7, and 8 respectively killing 133,103, 93,541, and 76,488 in that order. The correct answer, per a report by John Hopkins University, Medical Errors are the third leading cause of death in the US killing an estimated 150,000.

Another study released in the Fall of 2013 by the Leapfrog Hospital Safety Group places the number up to as many as 440,000. This estimate would place this cause just short of cancer and larger than the sum of the 4th and 5th leading causes together. Another way to look at this is we had 32,719 in traffic fatalities in 2013 or, on average, 90 people per day while at the same time, we had 1,205 people die from Hospital medical errors. In comparison, in the same year, 2013, there were no deaths related to commercial flight. The last deaths associated with commercial flights was in February 2009.

Where do these medical errors come from? Infections, surgical complications that go unrecognized, communication errors, diagnostic errors, and medication errors to include fluid overloads to name the major contributors. Why are aviation deaths so low yet medical errors are so high? Both involve many variable, some of which are outside of the control of the person responsible. For example, weather for aviation and pre-existing conditions and general health of the patient prior to the error.

It is my humble opinion that these differences lie in the culture each industry has developed. The aviation industry is very committed to safety. Continuous training, simulations, engineering, and a culture of teamwork all are critical in the aviation industry as well as self-reporting of both errors and near misses. These activities do not seem to be as valued in the medical community. Both industries are now primarily profit-centered but the aviation industry certainly has a much more difficult time of hiding any type of fatality behind a veil of confidentiality.

Regulatory agencies may also play a role, such as the power of the FAA versus the nursing or physician boards. If medicine would embrace simulations and engineering safety responses as much as the aviation field has done I believe we would see positive results. The medical industry also seems to operate more on a fear of being caught and rather than how can we learn and avoid this error in the future mentality. Another paradigm shift may also benefit if we focus on our Hippocratic oath and do no harm over our pre-occupation of self-preservation. A commitment to teamwork and the spirit that we all play an important role and share a vested interesting in a positive outcome from our care would also play an important role in reducing deaths due to medical errors. Finally, a change in thought process needs to occur where remediation is not punitive but instead preventative.