Iatrogenesis

In 2000, the Institute of Medicine (IOM) published the alarming results of a study it had conducted that projected as many as 98,000 annual U.S. deaths were a consequence of preventable medical mistakes. The medical community rests on the Hippocratic Oath — named after the ancient Greek physician, Hippocrates. Fond as they are of the Greeks, it is unsurprising that the medical community uses a Greek-rooted phrase, “iatrogenic complications,” or iatrogenesis, to describe these mistakes.

Whatever you call them, a new study by the National Center for Policy Analysis (NCPA), published in the April issue of Health Affairs shows the rate of these events has increased substantially since the IOM report. Included in their study, “The Social Cost of Adverse Medical Events, and What We Can Do About It,” is an estimate that there are as many as 187,000 iatrogenic deaths in hospitals and as many as 6.1 million injuries, both in and out of hospitals.

According to the study’s co-author and president of NCPA John Goodman, “Every time the health care system spends a dollar trying to heal us, it causes 45 cents worth of harm.” Goodman’s co-author Pamela Villareal says, “Your chances of dying from a cause other than the one you were hospitalized for are as high as one in 200.” Yikes!

The focus of the report is the cost of these events, estimated at between $4 billion and $9 billion dollars. In percentage terms, that is equal to between 18% and 45% of total U.S. health care spending in 2006, when the period was studied. The study suggests that the solution is to scrap the current malpractice system and instead compensate people for their injuries regardless of cause, thus giving hospitals and providers a direct incentive to reduce error rates.

I am not certain about the real world effects of the compensation component they suggest, but they are spot-on about scrapping the current malpractice environment; that’s the key to any improvement in these troubling statistics. Today we have a system that drives these mistakes underground. If the system doesn’t encourage an open and honest discussion of what went wrong and how to learn from the mistakes, we probably shouldn’t expect too much positive movement from punitive measures that will just be passed along as a cost of doing business.