In response to a report in the Minneapolis StarTribune newspaper regarding medical errors, I wrote the following unsolicited op/ed piece and submitted it. For some reason, they declined to publish it. Go figure. Anyway, interested in people’s thoughts on the following.
Cultural Authority and A License To Kill
Stephen Bolles, DC
24 August 2014
The report Hospitals Report Fewer Preventable Mistakes that appeared in the StarTribune on January 23rd offered remarkable insights into a tragic aspect of medicine in the United States: the preventable killing and maiming of thousands of people each year.
In 1999 the Institute of Medicine published an arresting report. Remarkable for the honesty of its self-assessment and stunning in its scope, the Institute estimated that as many as 98,000 people died every year due to preventable medical errors. As detailed online at justice.org, others examined the data as well, and their findings did not offer any comfort. The Congressional Budget Office found 181,000 severe injuries due to medical negligence in 2003; the Institute for Healthcare Improvement estimates there are 15 million [emphasis mine] incidents of medical harm each year; and HealthGrades (the nation’s leading healthcare rating organization) found that Medicare patients who experienced a patient-safety incident had a one in five chance of dying as a result.
To its credit, the hospital industry accepted responsibility for developing improvements in its practices, seeking to ensure the identity of the individual and the appropriateness of the location of any surgery or procedure. During a minor surgical procedure recently at the Mayo Clinic in Rochester, my teenage son was the subject of several and repeated efforts to validate who he was, what he was there for, and where the procedure was to take place.
Yet Jeremy Olson’s reporting underscores the reality that there is a long way to go. During a minimally invasive procedure more than a year ago, carelessness on the part of the anesthesiologist and surgeon killed my brother. The ‘poor outcomes’ of the procedure fell within ‘medically acceptable limits.’ I can’t tell you how comforting that is to his family.
But what should stand out to us as a society and culture is that we have acculturated ourselves to these ‘poor outcomes’ and abdicated any sense of outrage and externally controlled accountability. Why is this so? It is due to the dominance of medicine and the cultural authority that it carries. The unique dominance of the medical paradigm in our society and culture confers a perverse and distorted halo on its own actions, responses and accountability. Medicine and medical procedures constitute a number of important, critical—even miraculous—capabilities and opportunities for improved health, longevity, and optimal function. But these capabilities are one side of a two-edged sword, and we as a society are still letting some people get away with murder when the sword swings the other way.
Harsh as those words may sound, it’s instructive to compare medical errors with other causes of death and disability that we broadly accept as public health problems. We devote billions of dollars to research, treatment and prevention of two of the leading killers in America: heart disease and cancer. And we should: data from the Centers for Disease Control and Prevention for 2011 indicate that more than 1.7 million people died from these two diseases. The next category of respiratory diseases killed more than 138,000 people that same year. But our own doctors and hospitals may actually have been the third leading cause of death. Why have we not taken this on as a public health problem? We punish industry for polluting streams and wetlands; we regulate the quality and acceptability of our air, roads, baby furniture, electronics, and so on. Yet we leave the figurative fox in charge of the medical error henhouse by trusting medicine to do the right thing. For many people, that ‘right thing’ isn’t being done yet. And for potentially hundreds of thousands of people each year, every year of our collective inaction means more needless deaths and accidents.
In late 2013 The Journal of Patient Safety pointed out that the numbers of preventable deaths were, in fact, likely to be much higher than originally identified by the Institute of Medicine. Researchers found that 210,000-400,000 of hospital patient deaths annually should be possible to prevent. While the Institute of Medicine disputes those conclusions, other health economists affirm them.
Given the complexity of problems and issues we are required to grapple with each day in American society, calling out this problem may seem a little like piling on. The metaphorically glazed eyes of the American electorate are an understandable sign that we are saturated and overwhelmed with the scope of social problems and needs. Many seem intractable. But it should be pointed out that we give a ‘get out of jail’ pass to medicine in this area and trust it to fix itself in a way we would never permit, accept or tolerate in any other area, nor from any other profession. The cultural authority established by the dominance of medical practices, education and politics has figuratively pushed us back from believing we have a position and right to demand change. We have allowed and accepted the dissipation of the indignation and rage that rises easily in us in response to other social ills.
Why are we continuing to give medicine a free pass on this? When will we accept that the culture of medicine prevents itself from really fixing its own problems? How many more people have to die?
Stephen Bolles is a former chiropractic practitioner and current business development consultant. He lives in Eden Prairie.