"The tip of the iceberg" is a curious phrase. It's become merely a cliché for imminent problems lurking beneath the surface. But it takes on new meaning when you know the danger is real.
American health care is not the Titanic, going down in dramatic fashion after being hit by an iceberg. But dangers do lurk beneath the surface for those who enter the medical system, as a recent study published in the journal Health Affairs showed.
Underreporting of Medical Errors
About one of every three people who are admitted to a hospital suffers some form of "adverse event" there. An adverse event is a term used in healthcare analysis for infections and various complications - including complications caused by medication errors.
The study reported in Health Affairs was co-authored by medical professor Dr. David Classen of the University of Utah. His team used an analytical method called a Global Trigger Tool to examine the records of 795 hospital patients. The team found that 354 of them had experienced medical mistakes, infections, or injuries such as falls.
Also of great concern in the study's findings is the extent to which errors go unreported. According to the study, 9 out of every 10 errors are not reported. This is far higher than earlier estimates by the federal government and hospitals using a purely voluntary method of reporting that relied on administrative hospital records.
What Can Be Done to Prevent Errors
The only way for progress to be made on reducing medical mistakes is to keep a spotlight on the issue. "You just cannot rely on doctors and nurses to admit they've made mistakes," said Dr. John Santa, a primary care doctor who also directs Consumer Reports' Health Ratings Center. "The results of this study are disturbing and upsetting. People have a right to think they're going to get better when they go into the hospital, not worse."
So how does society keep that spotlight on? One way is through government watchdog agencies. The federal Agency for Healthcare Research and Quality should keep insisting on transparency in the reporting of errors. So should the Centers for Medicare and Medicaid Services (CMS). State departments of health, such as the South Carolina Department of Health and Environmental Control, should do the same.
The Centers for Medicare and Medicaid Services has already taken some steps toward more disclosure of data to the public on hospital mistakes. Under the leadership of Dr. Don Berwick, CMS has created a website called Hospital Compare at which the public can obtain information about hospital-acquired infection rates.
Creating an interactive tool like this is a step in the right direction. Efforts to improve transparency must show the full scope of the problem of medical errors, not just the tip of the iceberg. Only then can real change occur in the way hospitals do business.
Medical malpractice lawsuits also have an important role to play. Hospitals and healthcare providers who commit medical malpractice should be held accountable. Compensation that an injured person recovers is important not only for the person and his or her family. It also serves as a check on a medical system that urgently needs to find better ways to care for people rather than harming them while seeking to help.
