Can We Reduce Harm from Medical Care Itself?

M. Joycelyn Elders, MD – Former U.S. Surgeon General

When medical care itself goes awry, death and disability are absolutely the most awful outcomes that can happen. However, there are other significant losses.  The trust of patients in doctors, other health professionals, hospitals, and medical care itself can be diminished.   Doctors and medical staff can have their own doubt and disappointment in medical systems and in themselves.

Medical errors are significant problems in US hospitals.  There are too many; they occur too often, and many are preventable.

Medical errors are preventable events which either causes patient harm (an adverse event) or could have led to harm (a near-miss).  An adverse event occurs when patient receives medical care which causes harm to the patient. Adverse events are both preventable and non-preventable.  Ones which could have been prevented are considered medical errors.  Medical errors which can cause adverse events include an inaccurate or missed diagnosis of a disease, over treatment, physical or psychological injury, infections, pharmaceutical error and any other ailment which causes, pain, disability or requires further treatment.

Medical errors can occur anywhere in the healthcare system – hospitals, clinics, surgery centers, nursing homes, dialysis centers, pharmacies, or patient homes.  It may involve medical treatment, surgery, diagnosis, pharmacy, equipment, lab reports or other.  One in seven Medicare patients in hospitals experiences a medical error.(1)  There are numerous problems that occur too frequently during hospital stays, such as “adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities” (IOM Report, 2000, Ref. 2).

It all adds up, resulting in 10 percent of all US deaths being due to or associated with medical errors.

Medical errors are the third leading cause of death in the US(3, 4, 5).  Only heart disease and cancer exceed the number of deaths caused by medical error.

The National Institute of Medicine Report in 1999, “To Err Is Human” stated that 98,000 hospital patients die each year from preventable medical errors.(2)  Other more recent reports suggest that the number may be over 200,000 (3, 4, 5) or even as high as 400,000 (5) , based on the point estimates.  There are 35,416,020 hospital admissions each year.  The point estimate for the data is 0.71 percent of all hospital admissions die (6)

In addition to the approximately 1000 deaths per day in hospitals around the US, there are about 10,000 cases of serious complications resulting from medical errors that occur each day.

Medical errors cost this country a staggering amount – billions of dollars each year in hospitals nationwide, which includes the expense of additional medical care, lost productivity at work and home, disability and premature death, lost income and household productivity, and disability. (6)

The aim is to increase patient safety in American hospitals, and to get to “0” harm.  In order to get to “0,” we must know how to prevent harm.  In order to have a safety culture, we must have a:
•    A culture of open reporting,
•    A just culture,
•    A learning culture and 4) An informed culture.
The key to safety is to collaborate, be transparent, and be consistent.  In order to be transparent, we must:
•    Have early learning,
•    Steal good ideas and share them,
•    Work as partners,
•    Mentor and all be teachers and
•    All be learners.  We must have early prevention training, high reliability, accept human errors and medical errors. Respond quickly. We have to be timely, standardized, and have a quick response.  Be optimistic.  Focus on safety.

There are significant problems, such as ideology.  Ideology is multifactorial. Acknowledge that errors happen.  Recognize that they happen.  Share in the fact that they happen.  Be transparent. Hospitals must be willing to commit resources to reduce errors.  We all must speak up for safety and error prevention.

The incidence of death by medical errors is the equivalent of one 747 jet airplane crashing every day with no survivors.  Put in that way, we would all be aghast at the loss; people would be demanding attention to the problem.  But the loss due to medical errors is quiet and isolated, one location at a time, one person at a time 187,000 to 400,000 times per year.

While to err is indeed human, and to forgive may be divine, in this case it is time for us to stop Americans from having to forgive so many medical errors.  It is up to medical professionals to recognize the enormous loss and get to work to eradicate death and disability due to medical error.


  1.  Department of Health and Human Services, Office of the Inspector General. Adverse Events in Hospitals: National Incidence among Medicare Beneficiaries. Washington, DC; 2010, Available at:
  2. Kohn LT, Corrigan JM, and Donaldson MS, Editors; Committee on Quality of Health Care in America; Institute of Medicine  Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press, 2000. doi:10.17226/9728.
  3. Makary, M.A., Daniel, M. “Medical error—the third leading cause of death in the US.” BMJ 2016;353:i2139
  4. The Leap Frog Group. About the score.
  5. James JT. A new, evidence-based estimate of patient harms associated with hospital care.  J Patient Saf. 2013 Sep;9(3):122-8. doi: 10.1097/PTS.0b013e3182948a69.  Accessed from,_Evidence_based_Estimate_of_Patient_Harms.2.aspx
  6. Healthcare IT News. Erin McCann. “Deaths by Medical Mistakes Hit Records.” July 18, 2014., accessed on July 18, 2016.

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