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Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

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Re: Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

#221

Post by simonh »

ncmncm wrote: post #192
TaupeRanger wrote: post #121

Earlier quoted context omitted.

Unless the mistakes led to death that wouldn't have otherwise occurred in a similar timeframe, the anecdotes wouldn't even be relevant.

Mistakes don't sort neatly by causes into fatal and non-fatal. Some of almost any kind are fatal. Anything that prevented fatal mistakes would eliminate most others.

I’m not in the medical industry, and I’m a Brit and don’t know what the estimated stats are here. But the way I think about this is that medicine must be at least as complex and side effects are at a minimum as hard to anticipate as software development.

Bugs are a fact of life in development, nobody thinks software having any bugs at all is normal or that bugs are an irrefutable indicator of incompetence. That’s because anyone with any knowledge of Tyne subject has developed software and spent a huge part of that time fixing their own bugs.

The way you deal with that is through testing, defensive coding, making software maintainable, etc. You minimise the impact bugs have and try to ensure mistakes are recoverable. You also avoid counterproductive measures like punishing bug reporting, because that will just lead to cover ups and sweeping the problems under the rug.

The last thing we want to do is punish the reporting of medical errors. So yes I absolutely agree, and the way to do that is to build an honest and healthy culture around reporting of medical mistakes.

Re: Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

#222

Post by spaetzleesser »

sangnoir wrote: post #210
spaetzleesser wrote: post #161

Earlier quoted context omitted.

"installed for dubious reasons by a doctor that specialized in this particular type of leadless pacemaker" That's the problem with a fragmented health system. A lot of doctors are specialists in a certain procedure and want to repeat their pet procedure on every patient they see. I saw this with my ex who had chronic leg pain. Most of the doctors we met just wanted to repeat what they do every day (and makes them goo…

It's a double-edged sword. For surgeons, specialization improves outcomes as practice makes perfect. Since this is HN, I'll liken it to using the same programming language daily, versus being asked to fix a bug in a language you last used years ago, within a fixed time window. The only missing peace is the a doctor on the care team who chooses which type of surgery is best, becasue once one is referred to a specialis…

That doctor on the care team is usually missing. Actually I would guess that most people don’t have a “care team”. They are referred to a surgeon or other specialist that then does their pet procedure.

Re: Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

#224

Post by TaupeRanger »

deltaonefour wrote: post #154
TaupeRanger wrote: post #123

Earlier quoted context omitted.

Exactly. Every time I come to a medical thread on HN I realize how bad even intelligent people are at understanding medical statistics and recognizing when to raise an eyebrow of skepticism. It really does take a lot of study and/or professional training to develop those skills.

Interesting. I would be one of those people who can't fully understand the accuracy of these numbers, so I have to take other peoples' word for it. Are you part of the medical field yourself? If so then I wouldn't trust anything you say given that if the statistics were true, what you're saying has a high chance of just covering yourself up.

I'm not, but I've spent a lot of time over many years cultivating an understanding of epidemiology and med statistics, especially as they relate to study/trial design. The article linked above points out many of the problems with the parent's study. Medical errors are a problem, but we don't know much about it because of these problems, so I worry, as always, that people will take the wrong message away from headlines like this.

Re: Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

#225

Post by eftychis »

From personal experience and friends and family experience, I actually am surprised it is only 250k annually in the U.S.

> The researchers caution that most of medical errors aren’t due to inherently bad doctors, and that reporting these errors shouldn’t be addressed by punishment or legal action. Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability.

I respectfully disagree. All these are systemic problems as indicated and need to be solved by a revamp of the whole system. They are not magically going to fix themselves, there is no financial incentive to do so.

Re: Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

#226

Post by renewiltord »

rscho wrote: post #218
renewiltord wrote: post #213

Earlier quoted context omitted.

FWIW, in this respect, I'm just relaying from my parents: dad's an ortho trauma surgeon who now runs a trauma department, and mum's an ophthal surgeon. As much as I'd like to claim I'm casually reading the NEJM every day, I've only ever read papers they share with me, which they do at an annoying frequency considering I'm in trading. I assume the general silent belief would be that your guy with the spectacular failu…

> I assume the general silent belief would be that your guy with the spectacular failure is some kind of "take the tough cases" dude? No, the silent belief is that he's the worst surgeon we have. > they shut down the procedure in the remote hospitals and centralized it in a few (3?) tertiary healthcare centres. Do you recall something like that? That's become an extremely common strategy for specialized surgery throu…

> No, the silent belief is that he's the worst surgeon we have.

Haha, classic! I love it! I was honestly a little worried of offending you if he was a friend.

> That's become an extremely common strategy for specialized surgery throughout Europe.

There we go. Fine, I'll just go look it up.

Re: Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

#227

Post by ncmncm »

simonh wrote: post #221
ncmncm wrote: post #192

Earlier quoted context omitted.

Mistakes don't sort neatly by causes into fatal and non-fatal. Some of almost any kind are fatal. Anything that prevented fatal mistakes would eliminate most others.

I’m not in the medical industry, and I’m a Brit and don’t know what the estimated stats are here. But the way I think about this is that medicine must be at least as complex and side effects are at a minimum as hard to anticipate as software development. Bugs are a fact of life in development, nobody thinks software having any bugs at all is normal or that bugs are an irrefutable indicator of incompetence. That’s bec…

We already know the most effective way to reduce, and often eliminate, medical mistakes: rigorously applied checklists. They are still used only here and there, years after this was well demonstrated. It is well past time to treat not rigorously following checklists as negligent malpractice.

Medicine depends overwhelmingly more on manually applied procedures that would be automated, in a computer, as patients and staff manifestly are not. So, the same mistakes are repeated again and again. A software fix would correspond to changing a checklist.

Still, it would be no bad thing to use checklists for manual processes in software development, but I have never heard of any.

Re: Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

#228

Post by nradov »

spaetzleesser wrote: post #220
nradov wrote: post #197

Earlier quoted context omitted.

Who is "they"? Medical insurance companies don't really set deductibles. They offer a menu of options to customers (mainly large employers) and let them pick. Insurers are happy to offer plans with zero deductible, but the premiums will be higher. This is all based on actuarial calculations; insurers generally don't make any more profit on high-deductible plans. If you think your deductible is too high then complain…

The configuration of your health insurance is negotiated between insurance and employer. It seems pretty obvious that they are setting things up in a way that’s good for them.

You don't seem to understand how that negotiation works. Higher deductibles aren't good for medical insurers. In terms of insurer profit margin, higher deductibles are neutral to slightly negative. It's the employer (customer) who has complete control over deductibles. That is the reality of how the market works.

Deductibles are generally going higher because healthcare providers and pharmaceutical companies raise prices every year, and because we have an increasingly unhealthy population that demands more services. Insurers try to hold down those increases but with limited success, so they pass those costs on to their customers (employers), and those customers in turn pass on the higher costs to their employees.

Re: Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

#229

Post by corrral »

causi wrote: post #89
giantg2 wrote: post #67

“Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics,” That's because they're hard to standardize. What qualifies as a medical error? It's easy to go back after the fact and analyze a case where someone has a poor outcome and say 'we should have done this another way'. That doesn't mean there was any indicatio…

I'm a little skeptical that there are legitimately 250k that result in unnecessary death each year From purely anecdotal experience, that number is totally believable. Again anecdotally, the medical field seems to only have two kinds of people, the extraordinarily competent and dedicated, and people who don't give a whiff of a shit. The medical bell curve looks more like a bathtub.

My parents always warned me, based on their own experience, that you need a healthy family member watching doctors and nurses like a hawk at all times, looking into the drugs and dosages they're prescribing, and even doing work on diagnoses, to make sure they don't kill you, and that it was extremely risky not to have a competent, dedicated advocate of this sort around. I was always a little skeptical of this.

Now that I've had a little more experience with doctors and hospitals, I'd say they were spot-on.

Re: Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)

#230

Post by spaetzleesser »

nradov wrote: post #228
spaetzleesser wrote: post #220

Earlier quoted context omitted.

The configuration of your health insurance is negotiated between insurance and employer. It seems pretty obvious that they are setting things up in a way that’s good for them.

You don't seem to understand how that negotiation works. Higher deductibles aren't good for medical insurers. In terms of insurer profit margin, higher deductibles are neutral to slightly negative. It's the employer (customer) who has complete control over deductibles. That is the reality of how the market works. Deductibles are generally going higher because healthcare providers and pharmaceutical companies raise pr…

We are saying the same thing. Employers and insurance negotiate with each other for their own benefit and the employee is the sucker.
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