An Overview Of The Epidemic Of Medical Errors

Medical malpractice occurs when a medical professional, hospital or any other entity directly injures a patient through a negligent act or an omission (the failure to act). Mistakes performed by medical practitioners on patients can be considered medical errors, but may not rise to the level of medical malpractice. Although most people tend to use the words interchangeably, they are not synonymous. Medical errors cannot be remedied by law without the elements of harm, negligence, and the deviation from the standard licensed practitioners are expected to uphold. Presented by the health care industry as harmless procedural or technical mistakes that can be corrected before substantial harm has been inflicted to a patient, medical errors are precursors to malpractice occurrences.

Health care facilities and practitioners have recently decided to place an emphasis on correcting medical errors before they progress and turn into mistakes that could constitute malpractice, in hopes of avoiding future lawsuits. But with the rising rates of malpractice claims pursued by patients, it's evident that much more work needs to be done on the behalf physicians, administrators, lawmakers, and advocacy groups to improve the rapidly growing medical error and malpractice epidemic that the U.S. is currently facing.

This article will highlight the rates in which malpractice occurs, the issues currently being ignored by the health care industry, and the stifling effects the upticks in malpractice have had on the nation.

Medical Malpractice Regularity

According to a groundbreaking study conducted by the British Medical Journal, medical errors are now deemed the third leading cause of death - claiming a whopping 251,000 lives every year. [1] The journal's calculation of this alarming number of fatalities equates to approximately 700 deaths a day.

In the wake of this daunting report, a light has been cast on the issues that had once been ignored by the health care industry and hidden from the general public. Conversations regarding the state of the health care system are geared towards the incredibly ironic and disturbing notion that more people are dying at the hands of medical professionals than they are dying from conditions these professionals are supposed to help patients overcome. Medical conditions such as respiratory issues, strokes, and Alzheimer's trailed behind medical errors in the top leading causes of fatalities in the United States.

Putting Medical Malpractice into Context

Numerous reports about rising medical malpractice lawsuits, as well as the increasing quantity of fatalities per year echo the notion that the health care system is in dire need of reform. Despite this haunting and ever-growing epidemic, studies and polls conducted in the United States over time have continually concluded that the majority of Americans have have an optimistic inclination that the flaws in the system aren't that bad. However, as articles and court cases are given frivolous media attention by outlets, Americans are starting to second guess their opinions, as well as their belief that the care they receive is invariably excellent.

American Patients Perspectives

Americans seem to currently have mixed feelings towards the quality of health care they receive in the United States. Since 2001, Americans have had a relatively positive view on the quality of health care in their individual states, rather than the health care provided nationally. The only aspect of the system individuals have been incessantly unsatisfied with is its cost. As time has progressed, however, the satisfaction once eagerly displayed for the system has slowly dissipated. Fewer individuals, although still the majority, believe that they receive quality healthcare. Approximately 55% of adults claim to be satisfied now, which is a decline from the high of 62% in 2010 and 2012. [2] However, these numbers are only reflective of people's perception of one type of health care facility - hospitals - which evoked most people to poll that the care received during their overnight stay was excellent. However, most people rated urgent care centers, or walk-in clinics, as one of the lowest among all surveyed health care facilities, with a rating of three out of 10. As a result, one could conclude that most adults in the United States do not consider the health care they personally receive as excellent and perceive that the health care system as a whole must be better in other states. This is not the case. [3]

American Doctors' Perspectives

Ever since the release of several game-changing reports claiming that medical errors are the reason for a multitude of fatalities in the nation, a giant push to correct these errors before harm is inflicted has been embedded in the medical workplace. One of these reports titled “To Err is Human” was released in 1999, and sent a message that reminded physicians, higher ups, and lawmakers that the circumstances will continue to get worse unless systemwide changes are emanated. [4]

Since then, some changes have been implemented. Nonetheless, doctors' attitudes towards the alarming rates of medical malpractice have caused some physicians to go into survival mode. This means that doctors are aware that medical errors are happening regularly and causing injuries as well as fatalities, but instead of being more careful, they are opting to defensive strategies. [5] Rather than acknowledging medical errors and prioritizing a patient's health, doctors have chosen the “deny and defend” approach to malpractice claims. The misconception that acknowledgment of a physician's errors somehow leads to more lawsuits initiated by patients is very prevalent in the minds of doctors now.

An example of this would be the case of respected and revered Chicago doctor Tapas Das Gupta and the University of Illinois medical facility. [6] When Dr. Das Gupta had harmed a female patient by failing to remove a cancerous tissue in her spine during surgery, he immediately acknowledged this failure and apologized. The woman could have sued and garnered a large amount of compensatory damages in court, but, thankful for his candid and genuine apology, she decided to settle instead. Ever since the incident, the facility made it a rule for doctor's to stop denying these occurrences and own up to their shortcomings, especially when a patient's health is at stake. As soon as the facility began to prioritize patient safety, the rates of malpractice lawsuits filed against physicians at the medical facility drastically declined.

The Reality of American Healthcare

On a worldwide scale, the United States “ranks last among the 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives.” [7] In regard to the quality of care, the nation was dragged down the ranks due to the physician's inability to provide safe or coordinated care to patients. These numbers and issues reflect the rising numbers of medical malpractice cases in the country, as well as the increasing rate of deaths stemming from medical errors on the behalf of medical professionals and facilities. This data reveals that although Americans have rose-colored glasses on when it comes to the quality of health care, physicians in other developed and industrialized countries are outperforming the licensed professionals practicing within the United States.

Maximizing Patient Safety

Tens of thousands of people have not only been injured but have died from medical errors that could have been prevented. As the growing issue of medical mishaps and malpractice amongst patients are cast into the spotlight, the conversation regarding how to minimize the infliction of preventable injuries have been initiated by medical professionals, insurers and patients alike. Despite the numerous explanations researchers have conjured up as to why medical malpractice rates have skyrocketed, many have narrowed down the issue to a common issue: the lack of concern for patient safety. Considering that the improvement or sustainment of a patient's health is the goal of a medical professional, it may be difficult to believe that patient safety could now be considered an afterthought in the minds of practitioners. But the rising numbers of malpractice cases brought, along with the alarming number of injuries inflicted due to the negligence of medical professionals proves that the concerns for the health of patients has not been prioritized by the health care providers in the industry for a long while. Although there have been some signs of improvement in the fields of medicine, it has been insufficient. It's evident that technological innovations have undeniably revolutionized health care, however, “scant progress has been made in improving accountability.” [8]

Development vs. Safety

Studies show that in simpler times when the utensils utilized in medicine were a doctor's judgement, the compassion of a nurse and a few simple procedures, there were fewer precautions that needed to be taken. The use of coordination and careful planning that the new-age medical devices of today demand create room for more error on the behalf of doctors. Also, with the growing number of technological mechanisms being innovated, coupled with their sophisticated nature, there became a great need for a larger and more specialized medical team. The more practitioners a patient interacts with, the greater the window for error becomes. An invention developed in the 1960s called the modern intensive care unit (ICU) exemplifies this issue. Those who were and still are placed in this unit are exposed to state of the art medical utensils, devices and pharmaceuticals, each accompanied by knowledgeable medical professionals who were trained to handle them. A patient deemed perilously ill would likely be seen by a half a dozen specialists, such as nurses, respiratory therapists, social workers, clergy and several others, and would have a myriad of tests administered and lots of medicine prescribed. Unsurprisingly, patients located in the ICU would experience medical errors more than those in other units of a hospital. In fact, one recent concluded that “the average ICU patient experiences 1.7 errors per day, nearly one-third of which are potentially life-threatening.” [9]

As time has gone on, the obsession with progression in the healthcare industry (as with any industry) has undoubtedly overshadowed the importance of keeping a patient safe. An apparent shift in priorities is the culprit that many people consider most pivotal when solving the issue regarding the rising epidemic of medical errors. Ensuring the safety and good health of patients - which would be the crux of the existence of the health care system - has taken a backseat to the wonders of innovation and development. This issue is prevalent in just about any massive industry one could name, and in all of these flourishing corporations the same notion reigns true: “The hard work and vigilance needed to ensure flawless execution always seems less exciting than progress.” [10]

No Incentives for Quality Health Care

Many people perceive the state of the health care system through the scope of business. These researchers claim that that the absence of a “business case” for improving the quality of the industry is a major obstacle in the United States. [11] They state that since a flawless performance executed by doctors has never been rewarded, there is no reason for them to invest in quality. This means there are no incentives for doctors to perform well or even to care about the safety of patients.

For instance, it's evident that the higher ups in health care have emulated the practices used for commercial aviation. In both industries, safety is (or should be) a top priority, and they both share an insistence for teamwork and productiveness. However, there is one massive distinction between the two. When a fatal error occurs on a plane, or the plane crashes, each party, including the airline, the people on the plane and the pilot are affected by the error. Also, these errors are extremely difficult to hide in the commercial aviation business. Therefore, each party is more concerned with airline safety, because their life and/or reputation is at risk. Alternatively, in the field of health care, it is mostly patients who are subject to the adverse repercussions of subpar service or mistakes. Despite the medical errors or mishaps, a medical professional commits over the course of their career, they are still provided with the same amount of pay. Skeptics of this approach claim that pursuers of this occupation should not want to become a physician if they do not have a genuine concern for those they practice on. But that's the reality of these circumstances in a capitalist system. A constant hefty paycheck is available for those who meet the standard qualifications, and it's there even when their actions fall below that standard.

The Causes of Malpractice Suits and Patient Injuries

Occurrences of medical malpractice have been committed so frequently that medical databases have been established to record claims and suits to provide physicians with guidance. The top factors that contributed to patient injury paired with other key findings have been distributed to physicians in hopes of reducing risk and promoting patient safety. [12] A prominent database known as “the Doctor's Company” recently released a study outlining the top issues (based on expert reviews) that considerably contribute to patient injury. These factors are:

Problems with clinical judgement

The concept of clinical judgment in relation to medical malpractice may be hard to grasp due to its enormity. When someone makes a judgment call, they are doing so based on the best available information. The definition of clinical judgment is similar. It refers to the judgments physicians have developed through practice, experience, knowledge, and continuous critical analysis. Under the umbrella of clinical judgement resides the complications that arise during the process of assessing and monitoring patients. A few common examples of the actions or lack of actions exhibited by doctors that who assess and monitor patients are:

  • Lack of, or inadequate patient history and physicals
  • Failing to establish an accurate diagnosis
  • Misinterpreting diagnostic results
  • Failing to rule out or act on abnormal findings
  • Failing to administer or delaying diagnostic testing
  • Maintaining a narrow diagnostic focus (and ignoring the actual issue) [13]

Doctors have a hard time with diagnostics due to the fact that they are given the task of linking symptoms displayed by patients with actual clinical problems. Lapses in clinician experience and knowledge are what most consider the logical cause of errors in clinical judgment, but that is not the case. In reality, flaws in data collection, data integration, and data verification - which is supposed to be gathered during the doctor-patient encounter - is what researchers think is the main culprit for deficiencies in clinical judgment.

Communication (or the lack thereof)

Efficient communication is a crucial part of ensuring patients are safe and satisfied with the quality of care. Inadequate communication, or the lack of communication overall, could also be the factor that causes or exacerbates the infliction of harm in patients. Although there have been cases when something a doctor said was inaccurate, there are more examples of injuries or harm that happen because of what a doctor did not say. We see this in cases when doctors fail to adequately describe or warn of the risks associated with a surgical procedure, prior to the time patients undergo an operation. [14]

A recent example of this would be the commotion doctors caused when they failed to warn patients of the life-threatening and incredibly risky gastric bypass surgery. Considered the gold standard of weight loss surgeries, this procedure is complicated for even the most knowledgeable surgeons and has been known to give patients tons of complications. If a doctor highlights all of the advantages and omits the disadvantages of a procedure, resulting in injury to a patient, this could be considered malpractice.

Technical Skills

The technical skills of practitioners matter a great deal, especially when it comes to surgeons. In every other aspect of life, individuals are given the freedom to choose service providers who have more favorable outcomes and reviews. For example, if your car's engine light comes on and it needs to be serviced, consumers can search online for the mechanics with the highest ratings in their proximity. However, when it comes to health care, this option is not available. In fact, when a patient is given the opportunity to choose a surgeon to perform an operation, he or she is not provided with information or valuable resources that would aid them in making a logical decision. In spite of the high costs linked to health care and the deaths negligent surgeons have already caused, there is not a database available that casts a light on practitioners overall performance and skills. Until a database highlighting a doctor's rap sheet of medical mishaps is established, technical skills will remain one of the most prominent causes of suits and injuries in malpractice cases. [15]

Documentation

When a physician adequately documents the management of a patient under their care, they are protecting the health of the patient for years to come, even when their time with that patient is up. Believe it or not, documentation is a science of itself and is the only proof of the existence of successfully carried out operations, treatments, and care. It is imperative that physicians properly maintain the records of patients for various reasons. One of these reasons is the overall use of these records for the betterment of the health care system. Documentation is evaluated and assessed when the lawmakers are planning on proposing strategies to improve the system. On a much smaller spectrum, the legal system also relies on documentation to solidify the notion that medical negligence has occurred. A properly noted description of a medical procedure, prescribed medications or a diagnosis can make all the difference in a medical malpractice case.

Healthcare-Associated Infections (HAIs)

Healthcare-associated infections, also known as hospital-acquired infections, have become a very serious issue in the United States. According to a recent study conducted by the Centers for Disease Control and Prevention (CDC), about 1 in 25 American hospital patients are diagnosed with at least one infection solely related to hospital care. [16] As a result, HAIs are responsible for an estimated 1.7 million infections and about 100,000 deaths every year. Caused by fungi, bacteria, or viruses acquired in medical facilities, those who have the weakest immune systems are susceptible to these infections. The infections spread through things like catheters, ventilation systems, and injections have become resistant to antibiotics over time, which has made the likelihood of becoming very ill or suffering a fatality increase. These infections are preventable. If hospital staff follows procedures precisely and medical facilities are cleaned properly, rates could decline.

Not only have HAIs been affecting people physically, they have caused hospitals a great deal of financial issues also. Since people who are already unwell ultimately end up even sicker due to the infection, more treatments are needed to remedy patients, costing hospitals up to tens of thousands of dollars. A recent study estimated that the United States healthcare system currently pays a whopping $10 billion a year to treat HAIs. [17] Here is a list of the infections most commonly caught by hospitalized patients:

  • Surgical site infections (SSIs)
  • Meningitis
  • Methicillin-resistant Staphylococcus Aureas (MRSA)
  • Sepsis
  • Ventilator-assisted pneumonia
  • Urinary tract infections
  • Clostridium difficile
  • Carbapenem-resistant Enterobacteriaceae (CBE)

The Effects of the Medical Error Epidemic on Patients, Doctors, and The Health Care System

The Health Care System

Defensive Medicine

Doctors who have been through legal proceedings for committing acts of negligence, or their fellow counterparts who have seen it happen, are obligated to learn from these experiences and be more careful so as to no longer deviate from the standard of care they are expected to uphold. As medical malpractice occurs more frequently, what was once called “the divine profession” has lost its pizazz, especially in the age of what researchers are calling “defensive medicine.” Emerging as the backlash of the direct result of rising malpractice cases, defensive medicine is practiced when a physician departs from normal medical practice to protect themselves from being sued by a patient. [18] Although the effects can be seen as positive or negative, depending on the party and the situations, researchers have declared that the negative aspects of this phenomenon outweigh the benefits.

Since doctors are doing everything possible to avoid litigation, that means they are avoiding conducting risky operations on patients who may need them, thereby preventing patients from being admitted to the hospital and giving them the proper care they need. Other types of defensive medicine include, the performance of unnecessary diagnostic tests, prescribing unneeded medications, and increasing the days spent hospitalized that may not have been required. These unnecessary procedures and practices are slowly becoming normalized in the field of medicine, while simultaneously increasing the cost of health care and lowering the quality of the service provided. Also, the administering of invasive diagnostic tests and procedures could hurt a patient more than help them. The most dangerous aspect of the emergence of defensive medicine is the same continual theme highlighted throughout this article. The physician's main priority is no longer the health of the patient, it is the desire to reduce the chances of litigation. According to a study conducted by Jackson and Gallup in 2010, a whopping 73% of physicians (92% of which belonged to the private sector), admitted to practicing defensive medicine. [19] And this study projected the prevalence of defensive medicine seven years ago. With the upticks of malpractice cases and injuries, the number of doctors actively practicing defensive medicine may have increased throughout the years.

Doctors

Medical Malpractice Stress Syndrome (MMSS)

In the wake of the rising rates of malpractice cases being filed against medical professionals, a new condition has been created: medical malpractice stress syndrome (MMSS). This condition describes the experience that physicians endure in the aftermath and during the duration of legal proceedings ensued against them. Symptoms of this disorder have been described as feelings of loneliness, negative self-image, feelings of helplessness, feelings of hopelessness and depression. However, the condition is mostly identified after the case, when the behaviors seen in doctors with MMSS syndrome becomes strange. Studies concluded that physicians begin to operate in ways that are not conducive to a productive and flourishing medical practice and that they began to either work more or avoid work altogether during their remaining years before retirement. The patient-doctor relationship is strained because doctors are more irritable, and they are unable to focus and be as proficient as they once were before litigation. The most common way that doctors have coped with MMSS is to retire early, but some physicians who are most affected choose the another way out, physician suicide. [20]

When a doctor has committed an act of malpractice, some of them feel as if their honor and important role in society is stripped from them. The whole point of them becoming a practitioner was to help improve their patient's health. When they feel incompetent or start to feel insecure or discouraged when practicing medicine, the chances of a doctor succumbing to depression and committing suicide is exponentially heightened. This is why doctors should not be ignored in the process of litigation. They should learn from their mistakes and be compelled to not make the mistake again, it should not dampen or ruin their whole career in medicine.

Patients

Lack of respect and trust / Shortage of physicians

Obviously, patients are affected by the events of medical malpractice more than any other party. When an individual who may need the help of a medical professions catches wind of the medical malpractice injuries and claims in their city or state, they may be leery of checking themselves into the care of doctors. Also, it's inevitable for patients to feel less trusting of their practitioners after hearing the traumatizing news of debilitating injuries.

Also, the rising premiums created by the occurrence of malpractice may cause doctors to gravitate to other locations where premiums are low. This would cause all the doctors with clean records to move to these locations, while the doctors who have committed malpractice will be the only ones practicing in certain areas.

Remedying the Medical Error Epidemic

The increasing rates of medical malpractice that lead to the deaths of patients are a testament to the fact the issues pertaining to the quality of healthcare in America are serious. And these rates are only going to worsen if things stay the way they are. Fortunately, measuring the problem is the first step in repairing the condition of the system and restoring its qualities. How many steps need to be taken before the quality of care is at the level it should be is unbeknownst to anyone at this time. But the fact these issues are openly being discussed and acknowledged is progress.

Whether change happens or not depends on the actions of those who are aware of the problem. The release of another study in 1999 by the Institute of Medicine also highlighted the issues pertaining to the quality of care here in the United States. This group, much like the BMJ, rattled the public and invoked national conversation about the condition of the health care system. However, it's apparent with the release of this new study that not much has been done to improve these circumstances.

Footnotes

[1] Makary, Martin A., and Michael Daniel. "Medical Error-the Third Leading Cause of Death in the US." BMJ. British Medical Journal Publishing Group, 03 May 2016. Web. 07 Mar. 2017.

[2] Gallup, Inc. "Americans Rate Healthcare Quality High, Cost Low." Gallup.com. N.p., 09 Dec. 2016. Web. 07 Mar. 2017.

[3] Patients' Perspectives on Health Care in the Nation." A Look at Seven States and the Nation (2016): 1-42. National Public Radio, Feb. 2016. Web. Mar. 7.

[4] The IOM Report. "To Err Is Human." 284.5419 (1999): n. pag. Web. 7 Mar. 2017

[5] Wachter, Robert M. "The End Of The Beginning: Patient Safety Five Years After ‘To Err Is Human'." Health Affairs(2004): 1-12. Web.

[6] Sack, Kevin. "Doctor's Say "I'm Sorry" Before "See You in Court"." The New York Times. Nissan, 18 May 2008. Web. 7 Mar. 2017.

[7]The Commonwealth Fund. "US Health System Ranks Last Among Eleven Countries on Measures of Access, Equity, Quality, Efficiency, and Healthy Lives." The Commonwealth Fund. N.p., 16 June 2014. Web. 07 Mar. 2017.

[8] Y. Donchin et al., “A Look into the Nature and Causes of Human Errors in the Intensive Care Unit,” Critical Care Medicine 23, no. 2 (1995): 294–300. 1

[9] Same as above

[10] S. Leatherman et al., “The Business Case for Quality: Case Studies and an Analysis,” Health Affairs 22, no. 2 (2003): 17–30. 1

[11] Kreimer, Susan. "Six Ways Physicians Can Prevent Patient Injury and Avoid Lawsuits." Medical Economics. Advanstar Communications Inc, 10 Dec. 2013. Web. 07 Mar. 2017.

[12] Kienle, G. S., & Kiene, H. (2011, August). Clinical judgment and the medical profession. Journal of Evaluation in Clinical Practice, 17(4), 621–627.

[13] Cascella, Laura. "Clinical Judgment: Let's Think About Thinking." MedPro Group (n.d.): 1-9. Web.

[14] Levinson, Wendy, Debra L. Roter, John P. Mullooly, Valerie T. Dull, and Richard M. Frankel. "DigitalGeorgetown Home."DigitalGeorgetown Home. N.p., 19 Feb. 1997. Web. 07 Mar. 2017.

[15] Thomas, Joseph. "Medical Records and Issues in Negligence." MU Digital Repository. National Library of Medicine National Institutes of Health, 01 Jan. 1970. Web. 07 Mar. 2017.

[16] "Healthcare-Associated Infections." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 28 Nov. 2016. Web. 08 Mar. 2017.

[17] Septimus, Edward J. "Th Care-associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System." (n.d.): 1-8. Jama Intern Med. Web.

[18] Sekhar, Msonal, and N. Vyas. "Defensive Medicine: A Bane to Healthcare." Annals of Medical and Health Sciences Research 3.2 (2013): 295. Web.\

[19] Bogart, Patrick. "The High Costs of Defensive Medicine | Jackson Healthcare News." The High Costs of Defensive Medicine | Jackson Healthcare News. Jackson Health Care, n.d. Web. 07 Mar. 2017.

[20] "Sued and Nonsued Physicians' Self-reported Reactions to Malpractice Litigation." American Journal of Psychiatry. N.p., 1 Apr. 2006. Web. 07 Mar. 2017

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