New methods to minimise mass-scale patient deaths

On April 4, 2012, in Philosophy, Science, by Sanjeev Sabhlok

Medication errors are among the top 10 killers of people across the world.

At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented, according to estimates from two major studies.  Even using the lower estimate, preventable medical errors in hospitals exceed attributable deaths to such feared threats as motor-vehicle wrecks, breast cancer, and AIDS. [Source: Institute of Medicine, November 1999]

In addition,

WHO puts medical errors as among the top 10 killers in the world.  [Source] [Sanjeev: I have not been able to verify this information on the WHO website, but since this has been published both on Times of India and ABC, I'm giving it some credence.]

We hear about rock concerts against AIDS. Has anyone heard of a rock concert against negligent deaths caused by doctors (and nurses)? Clearly, its scale is far greater than breast cancer deaths, for instance. Something should be done to reduce this major cause of death.

Well, the good news is that:  

a) doctors are being taught to wash their hands after seeing EACH patient [see my blog post, and read Superfreakonomics],

b) nurses are being empowered to demand that doctors prove they've followed a strict checklist [see my blog post on this topic], and

c) patients are being issued bar codes around their wrist [Source]

Note I'm NOT blaming doctors for these accidental deaths. And I'm not even remotely suggesting that these actions are deliberate.

Doctors are only human and they will make errors, sometimes fatal. But to the extent these deaths and injuries are caused by negligence, lack of professionalism, over-optimism, and arrogance, doctors MUST be held to account.

The reputation of the medical fraternity can increase (at least with me) if the profession becomes more TRUTH-ABIDING and human, and less monopolistic in its behaviour.

Speak the truth, dear doctor. Admit your failings. And keep learning. Then you will rise to become a scientist – an intellectual status far greater than a doctor's. And who knows, you might even rise ultimately to become a philosopher (lover of wisdom). 

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I risk being seen as a doctor 'hater' by those who won't put in the effort to understand what I stand for. So let me assert once again at the outset that (a) I'm a fanatic for the scientific method and critical thinking, and that (b) I have no doubt that modern medicine is a force for great good. Without modern medicine few of us would have been alive today. Its contributions to human longevity have been enormous.

That having been said, though, the medical profession is replete with limitations of knowledge, lack of humility; or what Hayek would have called, pretence of knowledge.

Above all this is a failure of character. 

It is this failure of character that leads to arrogance and demands for regulating the common citizen's access to the truth and to what he/she can put inside his body. It is this arrogance that demands restrictions on the freedom of citizens, and monopoly powers for doctors. It is this arrogance that insists on not being held to account despite KILLING innocents without recourse. It is this arrogance that paints an image of saintliness while focused (almost) entirely on misleading the public about its 'competence' and padding its pockets.

Let me cite, in further proof of the chronic incompetence of doctors, the following short paragraph from Daniel Kahneman's Thinking Fast and Slow. Kahneman, as we all know, is the counterpart of Einstein but in the field of human nature. He has done more to identify human failings than perhaps anyone else before him, and to that extent is richly deserving of his Nobel Prize in economics.

A study of patients who died in the ICU compared autopsy results with the diagnosis that physicians had provided while the patients were still alive. Physicians also reported their confidence. The result: "clinicians who were 'completely certain' of the diagnosis antemortem were wrong 40% of the time".

[Note, these wrong decisions KILLED their patients. No recourse. No accountability. KILLED. Period]

[E]xpert overconfidence is encouraged by their clients: "Generally, it is considered a weakness and a sign of vulnerability for clinicians to appear unsure. Confidence is valued over uncertainty and there is a prevailing censure against disclosing uncertainty to patients.'

Experts who acknowledge the full extent of their ignorance may expect to be replaced by more confident competitors, who are better able to gain the trust of clients. An unbiased appreciation of uncertainty is a cornerstone of rationality—but it is not what people and organizations want. Extreme uncertainty is paralyzing under dangerous circumstances, and the admission that one is merely guessing is especially unacceptable when the stakes are high. Acting on pretended knowledge is often the preferred solution.

[Ha, note that the last bit was pretty close to what Hayek said in his Nobel acceptance speech.]

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