Confronting the “silent killer”

By David P. Lind, CEBS, and Yogesh Shah, M.D., M.P.H.’14

MegaphonePrimum non nocere is a principal precept of bioethics that health care students at Des Moines University and, we hope, worldwide are taught. So why, then, are we not concerned about having legitimate legislation that attempts to protect every patient from harm — even when the harm is mostly “silent” and assumed to be unintended?

If the Centers for Disease Control and Prevention (CDC) were to include preventable medical errors in hospitals as a category, it would be the third leading cause of death in the United States, behind heart disease and cancer. When it comes to reporting these mistakes around the country, however, doctors and nurses have been fired when they speak up. This code of silence is, to say the least, deafening. Medical errors, no doubt, have become the “silent killer.”

In its 1999 “To Err Is Human” report, the Institute of Medicine (IOM) called for a nationwide, mandatory reporting system for state governments to collect standardized information about “adverse medical events” resulting in death and serious harm. Interestingly, this call for a national reporting system was not implemented.

However, as of November 2014, 27 states and the District of Columbia now have variations of authorized adverse event reporting systems. As of this January, Texas now reports such events. Many of Iowa’s neighboring states, such as Illinois, Minnesota and South Dakota, have reporting requirements.

What about Iowa? Iowa has no reporting requirements.

To improve the care we receive, we first must understand how prevalent this problem is in Iowa and elsewhere. In 2010, Harvard published a report in the New England Journal of Medicine indicating that about 25 percent of all patients are harmed by medical mistakes. In 2014, Massachusetts completed a survey of its residents and determined that 23 percent experienced medical errors.

So are preventable medical errors in Iowa similar to these alarming reports, or is care provided within our borders somehow insulated from the dismal results found elsewhere? That becomes the big question — we simply don’t know. In Iowa, we have no single independent trusted source to publicly provide ongoing transparency on this silent killer.

There are different ways to scale over what authors Rosemary Gibson and Janardan Prasad Singh call a “wall of silence” in their book of the same title. A good first step for Iowa may be to establish reporting requirements, much like the other 27 states are now doing. Another more immediate strategy is to ask Iowans about their experiences — a simple process that establishes a baseline for later, more deliberate and actionable solutions to make safety-of-care a statewide priority. To ultimately improve patient safety and quality, public reporting and provider feedback are critical.

We must not tolerate secrecy and instead demand “sunlight” within the medical care we receive. A preventable medical error becomes egregiously intentional when nothing is done to prevent it from occurring again. By staying quiet, opportunities to learn and improve the quality of care will be lost.

Isn’t it time to take action?

David P. Lind is president of David P. Lind Benchmark, which provides customized data for employers to benchmark their benefit plans. He’s also president of the Heartland Health Research Institute, founded to conduct research on a broad spectrum of health care issues and provide unique solutions to both employers and the health care community. Yogesh Shah is associate dean of global health at DMU and a physician board-certified in family practice, geriatrics and hospice and palliative care.

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