The Most Easily Preventable Cause of Death (March 31, 2015)
If medical error was counted as such, it would be the third leading cause of death in the United States. THIRD. That is a statistic that I like to repeat frequently, partly because I still have trouble believing it myself. But it is true. 210,000 deaths a year is most likely a conservative figure. A better estimate would be over a thousand deaths and ten thousand "serious complications" per day.
And that’s from errors. When things go WRONG. That doesn’t even count what can still happen to you if everything goes according to medical plan -- you know, “the operation was successful, but the patient died”. My father, for example, developed excruciating back pain after his (probably unnecessary) cardiac bypass that disabled him and ruined the remainder of his life if not flat-out shortened it. And he would not be counted in either the “death” or the “serious complications” category.
What are these deaths from? For hospitalized people on Medicare, most commonly from medication mistakes. Medically-caused infections and procedural errors of various types look to be the other two members of the top three (as best I can tell with my limited search skills, anyway). Additionally, “lethal diagnostic errors” account for 40-80,000 deaths yearly. Remember that the next time you hear a doctor complain about how high his malpractice premiums are.
The first paper on this subject was published in 1998. Have there been improvements since then? Well, there may have been some decreases in hospital-caused infections in some places since Medicare started refusing to pay for them (yes, that’s what it took). And there are some institutions that have taken this to heart and are genuinely striving to lower their error rate, and having success, too. Good for them! But overall -- no. In fact, it’s gotten worse. Probably due to ‘… the increased complexity of medical practice and technology, the increased incidence of antibiotic-resistant bacteria, overuse/misuse of medications, an aging population, and the movement of the medical industry toward higher productivity and expensive technology, which encourages rapid patient flow and overuse of risky, invasive, revenue-generating procedures.” (emphasis mine)
In America medicine is a business – please do not ever forget that -- so profit and protection from legal challenge are the industry’s two greatest priorities. This is not to denigrate the many, many good people in medicine who are there to help. When the bean counters call the shots, there is just so much that even the most saintly participant in it can do.
So the most important part of staying healthy may be to stay out of the hands of the generally well-meaning professionals who want to help you do it. You want to stay healthy because once you become a patient you may easily become toast AT ANY MOMENT. Once you are in the system, you have very little personal control over what happens to you, no matter how vigilant you are. You need to stay out of the system to begin with. That suggests two courses of action.
One, of course, is to keep in mind the other main causes of death in the U.S. (tobacco, obesity/inactivity, alcohol) and live the way you were designed to. Since you decrease your chances of premature death and disease by 80% if you follow the healthy lifestyle rules, you're also decreasing your chances of winding up on the medical conveyor belt by 80% at the same time.
The second one, and this is way, way underappreciated by most Americans, is to go to the doctor or hospital ONLY WHEN IT IS ABSOLUTELY NECESSARY. Which is a whole lot less often than most people seem to think. One of the biggest mistakes we make is to underestimate the harm possible from even the most seemingly innocuous medical procedure.
Remember the yearly physical exam? That guideline has been quietly changed to “All adults should visit their health care provider from time to time, even if they are healthy.” Ha! Do you know why that is? Because unless you have a problem that truly calls for investigation, the procedures involved in investigating and treating “incidental findings” that a battery of tests will tend to turn up on a healthy person are more likely to get you in trouble than to help you.
For example, those tests and procedures that involve radiation. Whole-body CT scans were quite the trend for a while, and you get a radiation dose of about 1,200 mRem from one of those. After a radiation exposure of 10,000 mRem, your lifetime chance of developing cancer increases by 1%. And that’s a linear risk; twice as much means your chances are twice as great. (There is no minimum safe level for radiation, by the way. Even a teeny bit increases your risk by a teeny bit. And it’s cumulative.)
The current radiation dosage for a mammogram is about 40 mRem. It used to be a lot higher. In 1972 the estimated dose to the breasts per mammogram was in the range of 10,000-35,000 mRems. Let me put it this way. In 1972 ONE MAMMOGRAM WOULD HAVE INCREASED YOUR RISK OF CANCER BY ONE TO THREE-AND-A-HALF PERCENT. It takes seven to fifty years after exposure to radiation for the cancer it causes to show up. So how many of those ladies who dutifully went to the doctor for their yearlies over the last few decades are winding up in the morgue because of it? And that doesn’t even fall into the area of medical error, does it?
If you have a chronic medical condition, you MUST learn all you can about it and manage it conservatively. That means diet, exercise, and stress reduction. Also massage, chiropractic manipulation, acupuncture, herbs and nutritional supplements. People worry about the side effects of vitamins and herbs. There are so few deaths associated with these that no one even bothers to keep track of them. Yet the medical community is so busy digging at the specks of sawdust in the alternative community’s eyes that it ignores the logs in its own.
That does not mean to avoid medical care if you wake up one morning with your side paralyzed. It just means to use your judgment. When your doctor tries to give you a statin to lower your cholesterol, you might look into eating a little less cheese instead.
When it comes to medical and health care, you need to make the effort to actually appreciate risks and benefits. You don’t have to be an expert on something to get a good idea of this. If you are computer literate enough to read this email, you can look up your diagnosis and/or whatever test or procedure your doctor is recommending, possible risks and a good idea of whether it’s needed or not.
Once you enter the system and become a number, you can easily become a statistic. So use it and don’t let it use you. #
--dr. diane holmes
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