Medical Errors and. . . Deaths
Are Doctors Allowed To Make Mistakes?

This is a response to a commentary that appeared in the Philippine Inquirer editorial page, written by Thaddeus C. Hinunangan, a resident pathologist at the Philippine General Hospital: Are Doctors Allowed to Make Mistakes?

Godofredo U. Stuart Jr., M.D.

o, doctors are not allowed to make mistakes. Not in the noble intentions of medicine, framed in that motto phrased centuries ago by Ambroise Paré: Guérir quelquefois, soulager souvent, consoler toujours—To cure occasionally, relieve often, console always.

But in the practice of medicine, human error is inevitable. We assuage ourselves with half a proverb: To err is human. But because of medical errors, patients die.

In 2016, a British Medical Journal article put a number on the magnitude of the problem: Medical error is the third leading cause of death in the United States, after heart disease and cancer. Of the 2,597,000 deaths reported in 2013, there were 251,000 deaths caused by medical errors, third to heart disease with 617,000 and cancer with 585,000 deaths. (1)

  Medical error is the third leading cause of death in the United States, after heart disease and cancer.  
Heart disease                                611,000
  Cancer                                           585,000  
  Medical errors                               251,000  
  COPD                                             149,000  
  Suicide                                             41,000  
  Firearms                                           34,000  
  Motor vehicles                                 34,000  
BMJ/2016 (1)

While some have criticized the study as based on erroneous extrapolation, other studies have supported the contention that deaths occur due to medical errors, and that in the U.S. approximately 200,000 preventable hospital-related deaths each year is not unreasonable. (4) Another review of scientific literature on the contribution of medical error to US deaths extrapolated about 130,000 inpatient deaths a year from poor inpatient care.

In Ireland, a report estimated 1,000 unnecessary deaths are caused by medical errors every year in Ireland, with about 160,000 hospital injuries from medical errors. (7) Forbes reported that in the U.S., deaths from medical errors may be in the discrepant range between 44,000 and 400,000.

A Harvard Medical Practice Study found that 70 percent of errors resulting in adverse events were considered to be secondary to negligence, and more than 90% were preventable. (6) Another study reports that one out of every four patients hospitalized is harmed by a medical error. Aside from errors, experts say 20% to 30% of medical care is unnecessary.

In the Philippines, there were 582,183 reported deaths in 2016, an average of 1,591 deaths daily. The number one cause of death was heart disease 74,134, followed by neoplasms 60,470, pneumonia 57,809, cerebrovascular diseases 56,938. Medical error as a diagnosis and cause of death is nowhere in the list. (2) In 2017, a PGH retrospective chart-review study reported a 97.8% prevalence of medication errors in the Pediatric and Medicine departments. (9) The study made no mention if there were deaths caused by medication errors.

But it is not my intention to burden this blog with the studies and statistics. Rather, I write to assuage a young doctor who was plagued by a question: Are doctors allowed to make mistakes? No. . . doctors are not allowed to make mistakes; but they do. Medical errors are not uncommon in the practice of medicine. No matter our expertise, no matter our dedication to the science of healing, in the gray zones of the medicial profession's theater of life and death decisions, if we practice medicine long enough, there will be errors in our watch that will blindside and humble us--and from these errors, deaths will occur.

Death by medical error can be caused by commission, omission, ignorance, or neglect: an incorrect reading of an ECG, an x-ray or a slide; a wrong diagnosis; errors from a misplaced dot or decimal in a medication dose, a fatal drug interaction or an anaphylactic reaction; an erroneous interpretation of an abnormal laboratory result; interns and residents in teaching hospitals worked into the ground; a nurse's misreading of a chart order; a wrongful attribution of a serious complaint to something benign; a too hasty reading of a chart; doctors with antiquated knowledge and skills long gone; or, simply, errors caused by the too hasty visits typical of the ka-ching commerce of medicine.

Outside this hierarchy of errors, we have third-worldly realities: healthcare outcome compromised by virtual absence of peer-review; frowned-upon second opinions; quack doctors who have strayed far away from the science of medicine, instead, peddling their snake oils and preying on the desperation and hopelessness of the seriously ill patients; the disconnect between rural and urban medicine; and, of course, the poverty that consigns health care of many to fringe or substandard medicine, or no medicine at all.

In the Philippines, doctors are demigods, white coats flapping in seeming infallibility. When patients die, families accept the deaths in the belief that the doctors did everything they could; comforted by religiosity and consoled, often, that it was God's wish.The deaths from medical errors, seldom, if ever, leak out into the grapevine. There is a code of silence in the fraternity of doctors and in the institution of medicine that allows errors to be swept under the rug. And it will be a long time coming before medical error becomes a diagnostic entry in death certificates.

I applaud the young doctor for the courage and humility of his admission. (I'd like to think that his tears came from deep within, rather than caused by formalin.) These are qualities that will serve any doctor well in the countless scenarios in the practice of medicine, where death hovers and threatens, where deaths will continue to occur because of medical errors. Until that imagined time when medical errors are no longer swept under the rug, when truth and transparency prevail over silence and secrecy, we should be burdened with the task to ponder the deaths that we might have caused, that we might have contributed to, that we could have prevented. Each death can and should teach a lesson.

by Godofredo U. Stuart Jr., M.D.                                                                                         May  2018

Sources and Suggested Readings
Medical error - the third leading cause of death in the US / Martin A Makary, Michael Daniel /
BMJ 2016; 353 / doi:
Deaths in the Philippines, 2016 / Philippine Statistics Authority / Lisa Grace S. Bersales, PhD / Reference No: 2018-045 /
(Release Date: Feb 12, 2018)
Medical errors are not the third leading cause of death / Cory Fawcett, MD / Feb 13, 2017
Estimating Hospital-Related Deaths Due to Medical Error: A Perspective From Patient Advocates / Kavanagh, Kevin T. MD, MS; Saman, Daniel M. DrPH, MPH; Bartel, Rosie BS, MS; Westerman, Kim EdD, MFA / Journal of Patient Safety, March 2017; Vol 13, Issue 1: pp 1-5 / doi: 10.1097/PTS.0000000000000364
Measuring and Responding to Deaths From Medical Errors / Sumant Ranji, MD / Perspective on Safety, March 2017
Error Reporting and Disclosure
/ . / Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Chap 35
Medical errors causing 1,000 deaths a year, conference told / Marese McDonagh / Irish Times, Sept 8, 2017
Prevalence of Medication Errors in Admitted Patients at the Philippine General Hospital
/ Paul Matthew D. Pasco, Ruzanne M. Caro, Connie L. Cruz, Nerissa M. Dando, Iris Thiele C. Isip-Tan, Lynn R. Panganiban, Loralyn P. Pascua, Rosario R. Ricalde and Antonio C. Sison / ACTA Medica Philippina, Vol 51, No 2 (2017)

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