Apathy & swatting at tigers: A desperate call to action

Another in what has become a depressing string of studies — this time in the British Medical Journal — places medical error as the third leading cause of death in the United States, following heart disease and cancer.

Using conservative estimates of lethal preventable errors, Martin Makary and Michael Daniel from Johns Hopkins University didn't rely on new data. They simply examined studies that had already been published and applied the best science to the data.

One source came from the Harvard Medical Practice Study. One of that study's authors, Dr. Lucian Leape, later wrote in 1994 that annual death rates from medical errors were the rough “equivalent of three jumbo-jet crashes every two days.”

In other words, the news about harm caused by medical errors in the BMJ publication isn't new. Perhaps placing it in context among the top killers in the country will generate the action that is desperately needed.

But we can end medical error through diligence, application of proven best practices and putting a spotlight on why this oft-neglected killer lingers in our midst.

Twenty years ago, when the extent of the problem was first revealed, a number of intrepid physicians and researchers showed that errors were not inevitable byproducts of medical care. They were the result of human negligence and systems that weren't structured for zero mistakes. Airlines, aluminum, air traffic control, nuclear power — these are industries that operate with close to zero errors daily. That sustained excellence came from applying basic quality engineering techniques available to health care as well. But health systems apply these techniques sporadically as Band-Aids to fix a specific problem. They have yet to achieve enterprisewide, daily application. They have yet to establish a culture of safety.

The Pittsburgh Regional Health Initiative in 2002 rallied 32 local hospitals and they proved that it was possible to reduce central line bloodstream infections by 68 percent. We know that a 99-cent permanent marker can prevent wrong site surgeries (there were 59 in Pennsylvania in the current academic year, some even removing the wrong lung or leg). But such markings are not yet universal.

Hand washing can reduce the incidence of killer infections. But we are often below a 60 percent rate of hand washing in our hospitals. Pre-surgical checklists have been proven to reduce surgical errors dramatically. They remain optional.

The health initiative has done what it can to reduce errors. But we are not the answer. The answer lies in all of us. We have known for over 20 years that we had a serious problem; our national response has been apathetic. Four million people who have died from preventable errors since 2000 are the ghosts of our collective inaction.

The Centers for Disease Control and the broader medical and public health community need to make preventing medical errors a top priority. Americans have raised armies and gone to war for fewer deaths. Without an aggressive national effort and widespread accountability, those of us in the trenches will still be swatting at tigers.

Karen Wolk Feinstein is president and CEO of the Pittsburgh Regional Health Initiative.