A study done by a team of researchers from Johns Hopkins Medicine says medical errors should rank as the third leading cause of deaths in US. The research also points out that shortfall in tracking vital stats can hamper research and public might not even be aware of the problem. Dr Martin Makary, a surgeon from Johns Hopkins, was the lead author in the study. The study was published on May 2nd, 2016, in BMJ.

Dr Makary and his team urged for changes to be made in death certificates to better record deaths caused due to medical negligence. The team urged Centers for Disease Control and Prevention (CDC) to change the way it collects the country’s national health statistics, in an open letter. The team argued that reporting the leading cause of death is vital for better future assessments and policies. The team further added that the limitation in reporting is due to a historic policy that says death certificates can only be categorized using an ICD (International Classification of Diseases) code. So if a patient dies due to clinical negligence, his death won’t be reported as such which will be a misrepresentation of vital information.

By analyzing data collected over a period of 8 years, the Johns Hopkins study estimates that 250,000 US citizens die annually due to clinical mishandling. On the CDC’s official list for leading cause of death, it would be ranked third, behind heart disease and cancer which were each responsible for 600,000 deaths and above deaths due to respiratory disease, which caused 150,000 deaths in the year 2014.

The researchers elaborated medical error as an error in judgment, skill or care coordination, misdiagnosis, machine or system error, and a preventable adverse event such as an allergic reaction. But due to the limitations of the coding system factors such as diagnostic errors, lapse of judgment or communication gaps are overlooked and deaths in such circumstances are not recorded properly.

Dr Makary said, “You have this overappreciation and overestimate of things like cardiovascular disease, and a vast underrecognition of the place of medical care as the cause of death that informs all our national health priorities and our research grants.”

The chief of mortality branch of CDC, Bob Anderson, doubted that the agency’s coding system is an issue. He stated that complications due to medical care are mentioned on death certificates and codes do consider them. However, the CDC’s stats only consider the underlying cause of death, the disease for which the person sought treatment. So if the doctor listed the death as a result of clinical negligence, the results would not be included in the published totals. Only the underlying condition, such as cancer or heart disease will be included even if it was non-threatening.

According to Anderson, CDC’s policy is in accordance with international guidelines, allowing the death stats to be compared with other countries. He further added that it will be difficult for CDC to change the policy unless there was a compelling reason to do so. Anderson believed that it can be an uncomfortable situation for doctors to report negligence as cause of death. He said a more efficient strategy is to train doctors on importance of error reporting.

The researchers stated that by not recording the actual cause of death, the public will be unaware of the situation and proper funding on research will be affected especially if the death could have been prevented through extra care.

President of the National Patient Safety Foundation Dr Tejal Gandhi said her organization refers to patient harm as the third leading cause of death. She and Dr Thomas, whose research was published in Institute of Medicine’s “To Err is Human” report, both agree that better reforms should be introduced to accurately record medical data, since most causes of death are inaccurately reported.

Cause Of Death: How Can The Data Reporting Process Be Improved?

Since there aren’t many efficient techniques for recording patient’s death data, steps need to be taken to improve the reporting process. The first step is to establish the reason why the data is being collected. The next step is to figure out who will use the data, how it will be collected, when the data will be collected and where it will be collected. The plan should also consider how the data will be analyzed and processed.

For many of these steps, there should be an open communication between data experts and healthcare experts. Since the reason of death is a sensitive topic, consent should be taken from friends and family members beforehand. Health institutes such as CDC need to be more cooperative in the whole process and should try to understand that the data being collected will benefit the whole society by making the public more aware of clinical negligence and better funds will be made available for research.