Leadership

Preventable Deaths in American Hospitals

Article · January 23, 2017

Hospital medical errors are the third leading cause of death in the United States. That’s 700 people per day, notes Steve Swensen. “And most of those have a second victim: the nurses, doctors, social workers, managers, pharmacists involved in their care.”

How big of a factor is this victimization? And what can we do to prevent this tragedy, apart from addressing the cause of the preventable death?

In a Mayo Clinic study with the American College of Surgeons, 8.9% of participating U.S. surgeons reported the belief that they’ve made a major medical error within the last 3 months — and 1.5% believe their error resulted in a patient’s death, according to Tait Shanafelt. “When you think about that for a minute, it’s a staggering number,” Shanafelt says. Suicide ideation doubles in that 3-month window as well, he notes, independent of depression — the risk of which triples. “So when we make mistakes — and all physicians will make mistakes during the course of their career — it has a substantial toll on us. And there’s a strong link there with burnout.”

How do we mitigate that? By having a community of colleagues who support each other. “I just don’t think that people who are not physicians or not in the medical field can really fully understand what that experience is like for a surgeon who believes they’ve made such a mistake, with the exception of their colleagues,” says Shanafelt. “And so those communities need to be built ahead of time.” Mayo Clinic, for example, pays for its physicians to periodically go out for meals together.

Physicians are also often reluctant to seek mental health care for depression and suicidal ideation out of concern it will prevent them from renewing their license. Well-intentioned state licensing boards may ask appropriate questions such as, “Do you have a physical or mental health condition currently that impairs your ability to practice with skill and safety?” Or they may ask fairly draconian questions: “Have you ever experienced depression or been treated for depression at any point during your life?” The latter question has nothing to do with current conditions and impairment, explains Shanafelt, causing many physicians to self-prescribe antidepressants rather than seek care. We need to improve the way we’re asking these questions.

Christine Sinsky adds that, according to a Rand Corporation study, many things, such as EMRs, get in the physician’s way of delivering the best patient care, ultimately leading to physician dissatisfaction. “We have a very hazardous information environment that we’re working in, that well-intended, very potentially powerful tools are still somewhat immature and in unexpected ways have made care more hazardous,” explains Sinsky. We need to protect patients — and physicians — while in “this area of information overload, information underload, information chaos”.

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From the NEJM Catalyst event Leadership: Translating Challenge to Success at Mayo Clinic, June 2, 2016.

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