Medical Error stats

Tom Benzoni benzonit at GMAIL.COM
Thu Jul 7 18:04:36 UTC 2016


Joe:
Thanks.
Those are interesting thoughts.
Any discussion has to have parameters; I have been to too  many meetings
that strayed off course onto tangents.
Which is why they're called tangents! (Was that trig or geometry?)
tom

On Thu, Jul 7, 2016 at 11:29 AM, Joe Graedon <jgraedon at gmail.com> wrote:

> Dr. Benzoni,
>
> I know that this group’s focus is improving diagnosis and reducing errors.
> That is an extremely important goal and one that we totally support.
>
> It is only one part of the patient safety movement, however. Dr. Makary’s
> paper in BMJ created a firestorm of controversy within the medical
> profession.
>
> What started this thread was the rejection by so many of the data he
> presented. Since deaths attributed to diagnostic errors are an important
> part of the overall picture we fueled this debate by pointing out that Dr.
> Makary’s numbers may be an underestimate of the problem.
>
> We certainly understand that this discussion group should focus primarily
> on improving diagnosis in medicine. We would hope, however, that the
> broader question of patient safety would not be forgotten.
>
> Joe
>
>
>
> On Jul 7, 2016, at 11:48 AM, Tom Benzoni <benzonit at GMAIL.COM> wrote:
>
> Ladies and gentlemen
> We seem to be getting far afield from the original intent of this
> discussion group.
> It seems that folks have passionate feelings about topics that can be
> separated into threads.
> Consider making other discussion rooms or similar areas for these issues
> (other listservs, google rooms, etc.)
> Then let's back to discussing how we can tackle real world barriers to
> diagnostic nirvana.
> Tom Benzoni
>
> On Wed, Jul 6, 2016 at 7:37 PM, Joe Graedon <jgraedon at gmail.com> wrote:
>
>> Dr. Berlin,
>>
>> Your response reminds me a bit of the reaction we once heard from someone
>> else:
>>
>> “I wouldn’t believe it even if it were true.”
>>
>> Here is the abstract referred to below. You may wish to argue with the
>> authors. We are merely the messengers:
>>
>> Arch Intern Med.
>> <http://www.ncbi.nlm.nih.gov/pubmed/?term=berrington+de+gonzalez+projected+cancer+risks+computed+tomographic#> 2009
>> Dec 14;169(22):2071-7. doi: 10.1001/archinternmed.2009.440.
>> Projected cancer risks from computed tomographic scans performed in the
>> United States in 2007.
>> Berrington de González A
>> <http://www.ncbi.nlm.nih.gov/pubmed/?term=Berrington%20de%20Gonz%C3%A1lez%20A%5BAuthor%5D&cauthor=true&cauthor_uid=20008689>
>> 1, Mahesh M
>> <http://www.ncbi.nlm.nih.gov/pubmed/?term=Mahesh%20M%5BAuthor%5D&cauthor=true&cauthor_uid=20008689>
>> , Kim KP
>> <http://www.ncbi.nlm.nih.gov/pubmed/?term=Kim%20KP%5BAuthor%5D&cauthor=true&cauthor_uid=20008689>
>> , Bhargavan M
>> <http://www.ncbi.nlm.nih.gov/pubmed/?term=Bhargavan%20M%5BAuthor%5D&cauthor=true&cauthor_uid=20008689>
>> , Lewis R
>> <http://www.ncbi.nlm.nih.gov/pubmed/?term=Lewis%20R%5BAuthor%5D&cauthor=true&cauthor_uid=20008689>
>> , Mettler F
>> <http://www.ncbi.nlm.nih.gov/pubmed/?term=Mettler%20F%5BAuthor%5D&cauthor=true&cauthor_uid=20008689>
>> , Land C
>> <http://www.ncbi.nlm.nih.gov/pubmed/?term=Land%20C%5BAuthor%5D&cauthor=true&cauthor_uid=20008689>
>> .
>> Author information
>> <http://www.ncbi.nlm.nih.gov/pubmed/?term=berrington+de+gonzalez+projected+cancer+risks+computed+tomographic#>
>> Abstract
>> BACKGROUND:
>> The use of computed tomographic (CT) scans in the United States (US) has
>> increased more than 3-fold since 1993 to approximately 70 million scans
>> annually. Despite the great medical benefits, there is concern about the
>> potential radiation-related cancer risk. We conducted detailed estimates
>> of the future cancer risks from current CT scan use in the US according
>> to age, sex, and scan type.
>> METHODS:
>> Risk models based on the National Research Council's "Biological Effects
>> of Ionizing Radiation" report and organ-specific radiation doses derived
>> from a national survey were used to estimate age-specific cancer risks for
>> each scan type. These models were combined with age- and sex-specific scan
>> frequencies for the US in 2007 obtained from survey and insurance claims
>> data. We estimated the mean number of radiation-related incident cancers
>> with 95% uncertainty limits (UL) using Monte Carlo simulations.
>> RESULTS:
>> Overall, we estimated that approximately 29 000 (95% UL, 15 000-45 000)
>> future cancers could be related to CT scans performed in the US in 2007.
>> The largest contributions were from scans of the abdomen and pelvis (n = 14
>> 000) (95% UL, 6900-25 000), chest (n = 4100) (95% UL, 1900-8100), and head
>> (n = 4000) (95% UL, 1100-8700), as well as from chest CT angiography (n =
>> 2700) (95% UL, 1300-5000). One-third of the projected cancers were due
>> to scans performed at the ages of 35 to 54 years compared with 15% due to
>> scans performed at ages younger than 18 years, and 66% were in females.
>> CONCLUSIONS:
>> These detailed estimates highlight several areas of CT scan use that make
>> large contributions to the total cancer risk, including several scan
>> types and age groups with a high frequency of use or scans involving
>> relatively high doses, in which risk-reduction efforts may be warranted.
>>
>>
>> On Jul 6, 2016, at 2:57 PM, Leonard Berlin <lberlin at LIVE.COM> wrote:
>>
>> I can't comment on the accuracy about any of the other following "stats,"
>> but I certainly can about the
>>  "Excessive radiation CT scans:  29,500 (JAMA Int. Med.)! "
>>
>>  IT IS *ABSOLUTE NONSENSE*, based not  one iota on fact or data.  The
>> figure  is pure, unadulterated hypothesis and "projection."
>> *There has never been even one death supposedly due to radiation from a
>> CT scan!*
>>
>> Lenny Berlin, MD FACR
>> Skokie, IL.
>>
>>
>>
>> ------------------------------
>> Date: Wed, 6 Jul 2016 11:58:42 -0400
>> From: jgraedon at GMAIL.COM
>> Subject: Re: [IMPROVEDX] Medical Error stats
>> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>> David,
>>
>> We have been fascinated with the push back from the medical community.
>> Shooting the messenger is a time-honored tradition. Admitting that there is
>> a patient safety epidemic is a very hard thing to do.
>>
>> There is another way to assess health care harm. If one considers data
>> that has been collected from other sources this is what you discover:
>>
>> DEATHS ANNUALLY:
>>
>> Healthcare-associated infections: 75,000 (CDC data)
>>
>> Adverse drug reactions:
>> >100,000 (FDA)
>>
>> Misdiagnosis:
>> 40,000 to 80,000 (Pronovost, et al)
>>
>> C diff infections in nursing homes:
>> 16,599 (CDC)
>>
>> Excessive radiation CT scans:
>> 29,500 (JAMA Int. Med.)
>>
>> Unnecessary surgery:
>> 12,000 (JAMA)
>>
>> DVT/PE:
>> 119,000 (Cleveland Clinic) mostly occur in healthcare settings
>>
>> Surgical and post-op complications:
>> 32,591 (JAMA)
>>
>> There is some overlap, but when you consider most of these stats do not
>> include the outpatient setting I would argue that Makary's estimate is low!
>> Deaths from prescribed medications in the outpatient setting have been
>> estimated to be as high as 200,000 but no one really tracks them.
>>
>> Bottom line, how do we begin to fix a problem that remains out of sight
>> (not on the CDC mortality stats) and out of mind?
>>
>> Joe Graedon
>>
>>
>>
>> On Jul 6, 2016, at 10:51 AM, David Katz <d.katz at MAIL.UTORONTO.CA
>> <d.katz at mail.utoronto.ca>> wrote:
>>
>> Martine,
>>
>>
>> I disagree with your point. Nobody on this forum disagrees about the
>> importance of diagnostic errors, however, this paper was all about the
>> numbers. If an article about statistics and numbers is published in a
>> peer-reviewed scientific journal, like BMJ, then the numbers are extremely
>> important.
>>
>> I don’t disagree the issue is important regardless of the stats. As a
>> physician I am mortified that one mistake could lead to a single patient
>> death but the purpose of this paper was to comment on the stats and
>> therefore they must be held to the rigorous expectations of a
>> well-respected scientific journal.
>>
>>
>> David
>>
>>
>>
>> *From: *martineehrenclou <mge at martineehrenclou.com>
>> *Date: *Wednesday, July 6, 2016 at 12:10 AM
>> *To: *Society to Improve Diagnosis in Medicine <
>> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <IMPROVEDX at list.improvediagnosis.org>>,
>> David Katz <d.katz at mail.utoronto.ca>
>> *Subject: *Re: Medical Error stats
>>
>>
>> Worth the read but worth discarding as well.  Makery doesn't have to
>> publish his own study to justify the number of medical errors that end in
>> death.  It's certainly credible to cite other studies.
>>
>> I don't doubt that certain clinicians need to doubt medical error as the
>> third leading cause of death.  Even if it is the fifth, it's still too
>> much.  There is no way to eradicate the damaging stats given workplace
>> stress, short staffing, the unreliability of diagnosis, medication errors,
>> and more.
>>
>> All you have do is become a hospitalized patient yourself to realize the
>> number of medical errors that occur every day.  Try becoming a caregiver
>> for a patient with a serious illness or chronic medical condition, and
>> you'll wake up to the number of diagnostic errors, medication errors,
>> patient safety incidents in hospitals and ambulatory settings.  Until
>> you've been there it's too easy to dismiss.
>>
>>
>> Martine Ehrenclou, M.A
>>
>> Healthcare consultant
>>
>> Freelance journalist
>>
>> Award-winning author
>>
>> 310-502-5244
>>
>> Martineehrenclou.com <http://martineehrenclou.com/>
>>
>>
>>
>> On Jul 5, 2016, at 8:06 PM, David Katz <d.katz at MAIL.UTORONTO.CA
>> <d.katz at mail.utoronto.ca>> wrote:
>>
>> I am not sure if this has been circulated to the group yet but it is a
>> rebuttal to the BMJ Paper that claims medical error is the 3rd leading
>> cause of death.
>>
>> Definitely worth a read.
>>
>> http://www.bmj.com/content/353/bmj.i2139/rr-54
>>
>>
>> David Katz
>>
>> ------------------------------
>>
>>
>> <IMPROVEDX at list.improvediagnosis.org>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>> <IMPROVEDX-SIGNOFF-REQUEST at list.improvediagnosis.org>
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>> ------------------------------
>>
>> <IMPROVEDX at list.improvediagnosis.org>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>> <IMPROVEDX-SIGNOFF-REQUEST at list.improvediagnosis.org>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>
>
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20160707/cc098d56/attachment.html>


More information about the Test mailing list