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By Eric Van De Graaff, MD April 26, 2010 Posted in: Heart Health

It is estimated that 98,000 Americans die each year from preventable medical errors, according to a 2004 publication of the HealthGrades Quality Study, which called the issue of medical mistakes the “elephant in the room.”

“Medical errors seem to be the elephant in the room that no one wants to acknowledge or talk about.  The lack of recognition and acknowledgement of the seriousness and urgency of the problem fosters a culture of denial and complacency.  Also, our culture has typically viewed medical errors as a failure of people rather than systems, which prevents reporting and consequent analysis and solutions to prevent it from recurring.”

It was this report that prompted junior senators Hillary Clinton and Barack Obama in 2005 to jointly introduce a bill that would provide legal protection to physicians who voluntarily and expeditiously disclose medical errors to patients and families.  Five years earlier another Clinton, during his last year in office, announced an effort to curb deaths from medical errors by putting pressure on hospitals and clinics that receive federal funding to introduce policies to mandate mistake reporting and improve quality.

Despite these efforts, and many others, harmful medical mistakes still occur.  One such episode was the highly publicized tragedy involving the newborn twins of actor Dennis Quaid.  The two children received heparin, a blood thinner, at a dose one thousand times stronger than indicated for their small size.  Thankfully, they survived.  The staff at Cedars-Sinai readily admitted their mistake and placed the blame on “human error,” stating that they had safe processes already in place but that they were simply not followed.

More recently, Mr. Quaid, a private airplane pilot spoke at the National Press Club about the ordeal and compared the way we handle medical errors to the scrutiny applied to aviation tragedies:

“The airline industry doesn't have much choice,” Quaid noted in an interview Monday after speaking at a National Press Club luncheon. "When a crash happens, it's so public," he said. "No one is going to fly on their airplanes unless they have that trust."

But when a mistake occurs in a hospital, the public might never hear about it. Although an estimated 100,000 Americans die each year because of medical errors, their deaths are scattered over thousands of hospitals, "where people die anyway," Quaid said. "It doesn't get the same type of attention."

Mr. Quaid has a valid point.  Medical misadventures deserve greater scrutiny and the entire medical system needs to have mechanisms in place to allow us to tease out the root causes of error and correct them.  But he’s also viewing the problem a little simplistically when comparing the world of medical care to the aviation industry.

It is fair to compare a medical error (and its resultant harm) to an aviation mishap and suggest that medical mistakes be vigorously investigated.  But if we take the metaphor a step or two further it becomes clear that this analogy has only very limited utility.  In order for Mr. Quaid’s comparison to be truly valid we’d need to change the way we think about airplanes as such:

  • Our country would have 300 million airplanes, all flying each and every day, with new models coming off the line and old models being retired around the clock.
  • Each airplane, while essentially similar from the outside, would have a unique set of internal design, wiring, construction, and aeronautical characteristics.  No one set of blueprints would apply to all planes.
  • The pilots and owners would be free to maintain the aircraft any way they’d like.  Most would neglect routine maintenance and would launch the airframe into flying conditions that are clearly damaging.  While some would use clean fuel, oil, and lubricants, most pilots would dump filthy petroleum into the gas tank and try to get by on cheap and filthy grease—then be surprised when the engine runs poorly.
  • Older planes would gradually lose power over time, their moving parts would rust, and their flight controls would short-circuit and fail.  Navigation would freeze up, rudders would break, and landing gear would become unstable.  All this would be considered routine and no amount of equipment upgrades could slow the inexorable decay.  Still, they’d be expected to fly daily.
  • Every single airplane would eventually crash.  Some would crash after many years in service and others would go down early in their lifespan due to some design or construction flaw.  For some, the crash would be expected; for others, a sudden plummet from the sky and fiery explosion on the ground would catch all by surprise.  No aircraft would be simply mothballed or retained in a museum, and there would be no option for a failing airplane to not fly.
  • Aircraft would fail in a nearly infinite number of different ways—enough to fill textbook after textbook—and there’d have to be teams of highly specialized technicians to sort out the different system failures.

Now imagine the Federal Aviation Administration trying to deal with a world where airplanes are more like human bodies and aircraft crashes are as common as hospital deaths.

On the whole I agree with Mr. Quaid’s concerns and I’m glad he’s taken up the issue of medical errors as his cause célèbre.  To his credit, Mr. Quaid has assumed the banner of hospital errors and, among other things, is producing the documentary "Chasing Zero: Winning the War on Healthcare Harm" that will air on the Discovery Channel on April 24.

But in order to correct the problem we need to first understand the complexity of the issue.  No mechanical creation (even one as intricate as an airplane) will ever be as complicated, convoluted, and confusing as the failing human body. The multifaceted care that doctors, nurses, and hospitals are called upon to provide is staggering when it’s broken down into its individual parts.  During the course of one moderately complicated hospital admission the doctors and nurses cumulatively make hundreds of decisions and there are a thousand different critical steps where errors can occur.  With all the moving pieces it sometimes surprises me that more mistakes are not made and for this I credit the training of the staff and the detailed policies of the hospitals.

While we continually take steps to cut the rate of medical mistakes in a world where healthcare will always be more nuanced than aircraft maintenance, it pays to bear in mind that our progress will be slow and methodical.  Because, in the end, we’re still just fallible doctors and nurses trying to care for what is still the most complicated machine on earth.

Eric Van De Graaff, MD
Eric Van De Graaff, MD

Eric Van De Graaff, MD is a Heart & Vascular Specialist at CHI Health Clinic.

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