Medical error is the third leading cause of death in the United States, after heart disease and cancer, according to findings published this month in the British Medical Journal. 

As such, medical errors should be a top priority for research and resources, say authors Martin Makary, MD, MPH, professor of surgery, and research fellow Michael Daniel, from Johns Hopkins University School of Medicine in Baltimore, Maryland.

But accurate, transparent information about errors is not captured on death certificates, which are the documents the Centers for Disease Control and Prevention (CDC) uses for ranking causes of death and setting health priorities. Death certificates depend on International Classification of Diseases (ICD) codes for cause of death, so causes such as human and system errors are not recorded on them.

And it's not just the US. According to the World Health Organization, 117 countries code their mortality statistics using the ICD system as the primary health status indicator.

The authors call for better reporting to help capture the scale of the problem and create strategies for reducing it.

Cancer and Heart Disease Get the Attention

"Top-ranked causes of death as reported by the CDC inform our country's research funding and public health priorities," Dr Makary said in an university press release. "Right now, cancer and heart disease get a ton of attention, but since medical errors don't appear on the list, the problem doesn't get the funding and attention it deserves."

He adds: "Incidence rates for deaths directly attributable to medical care gone awry haven't been recognized in any standardized method for collecting national statistics. The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used."

The researchers examined four studies that analyzed medical death rate data from 2000 to 2008. Then, using hospital admission rates from 2013, they extrapolated that, based on 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error.

That number of deaths translates to 9.5% of all deaths each year in the US — and puts medical error above the previous third-leading cause, respiratory disease.


In 2013, 611,105 people died of heart disease, 584,881 died of cancer, and 149,205 died of chronic respiratory disease, according to the CDC.

The new estimates are considerably higher than those in the 1999 Institute of Medicine report "To Err Is Human." However, the authors note that the data used for that report "is limited and outdated."

Strategies for Change

The authors suggest several changes, including making errors more visible so their effects can be understood. Often, discussions about prevention occur in limited and confidential forums, such as a department's morbidity and mortality conference.


Another is changing death certificates to include not just the cause of death, but an extra field asking whether a preventable complication stemming from the patient's care contributed to the death.

The authors also suggest that hospitals carry out a rapid and efficient independent investigation into deaths to determine whether error played a role. A root cause analysis approach would help while offering the protection of anonymity, they say.

Standardized data collection and reporting are also needed to build an accurate national picture of the problem.


Jim Rickert, MD, an orthopedist in Bedford, Indiana, and president of the Society for Patient Centered Orthopedics, told Medscape Medical News he was not surprised the errors came in at number 3 and that even those calculations don't tell the whole story.

"That doesn't even include doctors' offices and ambulatory care centers," he notes. "That's only inpatient hospitalization resulting in errors."

"I think most people underestimate the risk of error when they seek medical care," he said.

He agrees that adding a field to death certificates to indicate medical error is likely the way to get medical errors the attention they deserve.


"It's public pressure that brings about change. Hospitals have no incentive to publicize errors; neither do doctors or any other provider," he said.

However, such a major step as adding error information to death certificates is unlikely if not accompanied by tort reform, he said.

Still, this study helps emphasize the prevalence of errors, he said.

Human error is inevitable, the authors acknowledge, but "we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences."

They add that most errors aren't caused by bad doctors but by systemic failures and should 'not be addressed with punishment or legal action.


Dr. Cinque: So, what do they mean by "systemic" errors as opposed to doctor error? Do they mean that the doctor followed the standard protocol but the protocol was wrong? That's what it sounds like to me.

First, note that this has been reported before that medical errors are killing people on a grand scale. I mean: it has been known for decades. And they said then that steps were going to be taken, etc. etc. to reduce the medical carnage, but obviously, it hasn't worked. Second, medical deaths are still being grossly underreported. Take heart disease, for instance, the leading killer. If a person dies from the adverse effects of medications for heart disease, such as calcium channel blockers which are dangerous because they can trigger heart attacks, it's likely to be called a death from heart disease rather than heart disease treatment.  

I'll admit that my perspective is very bleak. I think that most of medical treatment is killative.  Leastways, most of it is harmful. Most of it amounts to suppressive, symptomatic, pharmaceutical tinkering which adds a new abnormality to the ones you've already got- complicating your condition, even if in some ways it seems better or looks better. They are not making you healthier; they are just making your disease manifest differently as you continue going downhill.

A good example are diuretics which are very widely prescribed but rarely do anybody any good. You're better off living with whatever fluid retention you have than trying to get rid of it forcibly that way. Better yet, take some constructive actions with diet, salt restriction, weight loss, exercise, supplements, and perhaps fasting to see if you can get it to resolve naturally and spontaneously through actual biological improvement rather than forcing measures. What's so terrible about that? Remember, patience is a virtue. You start doing the right things, and then you give it time. There is no need to resort to anything reckless and drastic. 

This whole thing is complicated by the fact that there are areas in Medicine in which they do do valuable and beneficial things, such as surgery for cataracts, giving Metformin to Type II diabetics, antibiotics when necessary, and hormone replacement when indicated, especially when they are bio-identical. And I have no doubt that great work is being done with stem cells, and more is to come. But, none of that changes the fact that most of modern medical treatment is just disruptive pharmaceutical tinkering, which is hurting people and sometimes killing them. As a percentage, there isn't that much good in Medicine, and most of it should be avoided. 

Does that seem radical? Well, I'm sorry, but it's true.