Is medical error really the third leading cause of death in the US?

A recent claim that medical error constitutes the 3rd leading cause of death in the US has been challenged by Mary Dixon-Woods, our co-Director and new RAND Professor of Health Services Research. As reported in The Guardian, Professor Dixon-Woods and Kaveh G. Shojania – both editors of BMJ Quality and Safety – responded to a widely-reported BMJ article by Marty Makary and Michael Daniel that put medical error just below heart disease and cancer as a cause of death in the US.

First, according to Professor Dixon-Woods, the estimate fails the plausibility test. Of around 2.5M deaths in the US each year, approximately 700,000 occur in hospital.  ”We – and many clinicians and researchers – find it very hard to believe that one in 10 of all US deaths, or a third of inpatient deaths (the 251,454 estimated by Makary and Daniel) result from ‘medical error'”.

Second, Makary and Daniel do not provide any sort of formal methodology. To get their estimate, they aggregated studies using different methodologies and denominates, and provide no indication of confidence intervals. Though Makary and Daniel  argue for medical certification of death to include consideration of preventable complications, Dixon-Woods and Shojania point out that recent studies using medical review  estimate that around 3.6% of inpatient deaths have at least 50% probability of being preventable. Applying this rate of preventability to the total number of hospital deaths in the US each year produces an estimate of about inpatient 25,200 deaths annually that are potentially avoidable – roughly 10-fold lower than the estimate advanced by Makary and Daniel.

Finally, Dixon-Woods and Shojania point out, having the field of patient safety focus entirely on death has distorting effects. Just as most deaths do not involve medical error, most medical errors do not produce death—but they can still produce substantial morbidity, costs, suffering and distress. Drawing attention only to death as the focus of patient safety efforts risks drawing resources away from many settings of care – including almost all non-hospital environments – where death is not the most relevant outcome.

Response to claim about third leading cause of death

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