Hospitals are dangerous places to be. Doctors’ offices aren’t very safe either. By one estimate, as many as 187,000 patients die every year for some reason other than the medical condition that caused them to seek care. By another estimate, there are 6.1 million injuries caused by the healthcare system, including hospital-acquired infections that afflict one in every 20 hospital patients.
Although some have questioned whether these estimates err on the high side, even the most optimistic estimates of hospital safety are unacceptably high.
Adverse medical events (also known as iatrogenic events) are typically divided into three categories: preventable and negligent; preventable but not negligent; and other adverse events. Events in the first category, also called malpractice errors, are injuries or deaths resulting from medical misconduct or lack of adherence to minimum standards of care. Examples are performing surgery on the wrong site, or leaving a sponge in a patient after an operation. Events in the second category are considered avoidable, although they are not the result of negligence. Most hospital-acquired infections are examples of this sort of medical error. The third category is “other” events. These are events that we do not know how to prevent with our current knowledge and technology.
As it stands, malpractice lawsuits are the only recourse patients have to adverse events. Yet only about one in four adverse events falls into the category of malpractice. Even if the malpractice system worked perfectly—and even if patients are prepared to go forward with the expense and stress of a lawsuit—we are basically unprotected against three-fourths of all the things that can go wrong in hospitals.
Our system for dealing with these events is highly imperfect. Only 2 percent of victims of malpractice ever file a lawsuit, and fewer still ever receive any compensation. On the other hand, 37 percent of lawsuits filed involve no real malpractice. To add insult to injury, more than half the money spent on malpractice litigation goes to someone other than the victims and their families.
What can be done to make the healthcare system safer for patients? We will examine this topic in future installments. For more details, please consult my book Priceless: Curing the Healthcare Crisis.