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The 2nd Great Lie: The Institute of Medicine Report

Hossfeld, George MD

doi: 10.1097/01.EEM.0000368099.94333.4c
You've Been Served

Dr. Hossfeld is an assistant professor of emergency medicine at the University of Illinois-Chicago. He is a past president of the Illinois College of Emergency Physicians, and has been involved in the legal side of emergency medicine for more than 25 years.



Listening to all the “experts” tell us what is wrong with our health care system, we ought to be very skeptical about accepting any of the premises, facts, or figures glibly used to make a point. Mark Twain said there were three kinds of lies: lies, damn lies, and statistics. One of the more frequently quoted studies condemning medical care, for which we have the Institute of Medicine to thank, tells a statistical lie of epic proportions. It's become a kind of urban legend. You've all heard it. Most of you don't know its fallacious genesis. We can call it “The Second Great Lie.”

The only reason I know its origin was that I took the considerable time needed to research it. What I found was an embarrassing piece of pseudoscience that has attained the status of fact, primarily because it has been repeated so often.

In 1999, a prestigious body, the Institute of Medicine (IOM), published a study called “To Err is Human: Building a Safer Health System.” This esteemed body was full of academia's finest professors from universities and medical schools across the country. It has been suggested that the IOM was out to draw attention to itself with an electrifying proclamation because many of its previous ones garnered mostly yawns. It goes without saying that an exposé would get the most media attention.

Sure enough, the IOM reported its fallacious findings in a manner sure to grab national headlines: Medical errors kill up to 98,000 per year. No one looked further to find that the report was taken from poorly controlled chart reviews up to 15 years old that broadly guesstimated medical errors and then speculated if they were preventable. “Medical error” was undefined. Even more to the point, there was no effort made to relate so-called medical errors to a patient's course of illness or death. Put another way, of how much concern is a medication rash in a patient who died of lung cancer? Nevertheless, the IOM decided that these poorly designed, retrospective, subjective chart reviews were powerful enough to extrapolate to the entire U.S. death rate!



I'm not condoning any medical errors as acceptable. Every health care worker I know really and truly cares about patients and aspires to excellence. It's indisputable, however, that the IOM had an agenda extending far beyond reducing medical errors. You have to really want to champion their message to overlook the flawed methodology and utterly grandiose conclusion.

For as unsubstantiated a report that ever was written, the damage caused by the IOM report has been monumental. The fact that it came from an assembly perceived to be “medical” gave enormous credibility to those who would slander us. This pronouncement has been repeated ad nauseam to inform the public, and juries, how “doctors admit to killing nearly a hundred thousand patients each and every year.”

I honestly can recall very few deaths that I would classify as “unnecessary deaths due to medical error.” Sure, I've seen errors. Errors of judgment made by sincere but human practitioners doing the best they can with limited data and resources. That's hardly limited to the medical profession, is it? Let he who has reached perfection teach the rest of us.

The initial 1999 estimate of “at least 44,000 and as many as 98,000” patient deaths per year has been extrapolated to now pronounce “medical error” as the leading cause of death in America! The obvious conclusion to be drawn is that one would be a fool to go anywhere near a hospital! Fortunately, the public is just as skeptical as we, and they have voted with their feet. ED visits continue to rise. When an attorney cites the IOM report to bias a jury, he knows full well that it is malarkey. So much for the pursuit of truth in the courtroom.

Now, I expect to hear protests. No one doubts the wisdom of continuous improvement. But have you ever noticed that those who make these doomsday predictions (whether it is the swine flu, the economy, or global warming) always seem to have a vested interest in their predictions? The IOM authors created the stir they desired, and got the prominence they craved. Their careers flourished at the expense of our collective reputation. Thanks, guys.

It is speculation that the deluded souls who wrote the IOM report actually believed their numbers or they never expected them to be taken literally. Regardless, I can only imagine how many dedicated, faultless doctors were found guilty at least partly due to a jury that didn't fully understand the case, but thought: If doctors make this many mistakes, then chances are this guy did, too.

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Recourse Against Misleading Testimony by Expert Witnesses

The American College of Emergency Physicians will evaluate the statements of expert witnesses provided in medical malpractice cases, whether expressed by formal report, deposition, or testimony.

The expert's statements are reviewed for false or misleading information or opinions without medical foundation on behalf of plaintiff or defendant. ACEP may impose adverse consequences for unethical activities, including formal disciplinary action.

Call ACEP at (800)798-1822 to speak with the ACEP General Counsel or read “Procedure for Review of Testimony Regarding Standard of Care in Emergency Medicine” and “Procedures for Addressing Charges of Ethical Violations and Other Misconduct.”

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About You've Been Served

This column is dedicated to the thousands of committed physicians and other health care professionals, who despite their best efforts, devotion, and selfless lives committed to the best patient care, wound up in the defendant's chair on a malpractice suit. At best, I hope this column has an impact on litigation reform, abandoning the unrealistic, unattainable standard of care that has been set as perfection. At a minimum, I hope to serve as a sounding board for the countless professionals who have been subjected to personal attacks by the very patients we have vowed to help. — GH

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