Quora Question: Are Medical Errors the Leading Cause of Death in the U.S.?

A surgeon washes his hands before entering an operating room at the Ambroise Pare hospital in Marseille, France, in April 2008. Jean-Paul Pelissier/Reuters

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Answer from David Chan, MD from UCLA, Stanford Oncology Fellowship.

Medical errors are the leading cause of death in America only if one assumes that the mortality rate for life is zero.

The kind of analysis used in the studies is based on flimsy assumptions and projections that are then magnified by extending a bad study to the entire population of the country.

In America, a large number of people die in the hospital because of illness associated with age and disease compared to other countries where these same patients would die at home or in a board and care. American culture and society being what it is, our elderly and ill patients are hospitalized to attempt treatment with advanced technology for medical conditions that cannot be remedied.

I'm not talking about patients with community acquired pneumonia, appendectomies and repairing broken hips.

What I'm talking about is patients with advanced untreatable cancer, elderly patients with multi-system failure such as a diabetic patient with stroke, heart attack, kidney failure and infections of devascularized feet where most of the foot is dead tissue and rotting flesh.

So we have prolonged hospitalization of these poorly treatable patients leading to hospital acquired infections from infected central lines, pressure sores, aspiration pneumonia and antibiotic resistant bacteria because healing in this kind of situation is next to impossible.

Medical errors in hospitals do occur because doctors, nurses, pharmacists aren't machines. But the errors aren't the leading cause of death in the hospital let alone the United States. Given the infrastructure of very high end technology and equipment, the training and staffing of American hospitals with highly selected physicians and nurses, medical errors are rare compared to other countries.

American hospitals are data tabulated and surveyed for certification continuously by outside agencies and internal data is collected extensively.

American doctors and hospitals are so aware of this that they are trying to mitigate their risk. I see patients being transferred to nursing homes too early so that the pressure sores belong to the nursing home rather than the hospital. There are performance penalties for pressure sores. More on this later.

I now see surgeons refusing to operate on patients with borderline health issues to keep their mortality numbers low. The surgeons are afraid.

This past year, I had a very competent thoracic surgeon refuse to operate on an 80-year-old women with lung cancer because she was too obese. I also had a specialty trained rectal surgeon refuse to operate on an otherwise healthy 90-year-old with colon cancer. Five years ago, these patients would have had their surgery, survived and been cured of their cancer. I've heard cardiologists complain that cardiac surgeons wouldn't take complicated cardiac patients for coronary artery bypass for risk of affecting their numbers.

This is the kind of craziness generated by "performance" standards. You want to have really good numbers? Don't operate on anyone who is sick.

Unintended consequences.

On pressure sores. Elderly chronically ill patients have tissue thin skin. We've all seen it on our grandparents who have huge bruises on their forearms and shins without having bumped into anything memorable. So these patients have to be turned frequently because using protective padding isn't effective. But the process of turning patients creates friction against bedsheets and also breaks the skin. There is no way to win because lacking a machine for time travel, nature can't be reversed.

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