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Guns dont kill people, doctors do.
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95 Thesen
medicine forum beginner


Joined: 28 May 2005
Posts: 48

PostPosted: Tue Aug 02, 2005 2:29 am    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Saying that "the patient would have died anyway in 3 months
according to the statistics" is like saying a hit-man doesn't
really kill people because they are going to die anyway.

I have seen too many and talked to too many people who were
overmedicated and who did not have the expertise to change
their dosage of something. Whatever the medication a
physician prescribes for me, I always take half the recommended
dosage at first (except for antibiotics) to see how the compound will
affect
me.

David H
~~~~~~~~~~~~~~~~~~~~~~
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Quintal
medicine forum beginner


Joined: 23 Jun 2005
Posts: 7

PostPosted: Sat Jul 30, 2005 7:53 pm    Post subject: Re: Med Errors and Hard-Boiled Defective Stories (Re: Guns dont kill people, doctors do.) Reply with quote

On 28 Jul 2005 12:07:30 -0700, "Sbharris[atsign]ix.netcom.com"
<sbharris@ix.netcom.com> wrote:

Quote:
No. It was based on the numbers of people who died *of* the medical
error/accident.

COMMENT:




Quote:
Repeating it won't make it so. THERE WAS NO CONTROL GROUP.

ahah excellent. you've just repeated it, with caps, thinking it would
make it so.

Any reference, beyond claims, of the study in question?

Quote:
And without
one, you cannot TELL who died OF the medical error (usually). All you
can tell is that they died AFTER it, and take your best GUESS as to
whether or not this very ill person would have made it, if the error
had not occurred. I've appended a number of abstracts pointing out all
this out, and even one in which the doctors actually tried to do a best
guess as to whether or not error made in hospitals were indeed fatal,
using the baseline that the patient would otherwise would be expected
to have left the hospital and lived another three months.

Remember, please, that as patients who are dying of cancer or old age
or some chronic disease become more and more frail, they become more
and more like a house of cards with too many cards. It becomes more and
more difficult to do ANYTHING for them without small imperfections in
your technique causing possibly major problems. Or to put it another
way, getting them to live through any interventive procedure takes
greater and greater skill until finally you hit the wall where only the
best surgeon or intensivist on the planet *might* be able to get them
through the next infection or stint on the ventilator or surgical
procedure (which they need to survive another couple of weeks) but that
person isn't available. That's *how* people often die if you have no
hospice and nobody is willing to "give up." Sorry. And you can always
witchhunt and find somebody to blame. Indeed, if the doctors refuse to
do anything, knowing that doing anything will probably be useless
and/or carry a high degree of causing yet more problems, you can always
fire them and find a doctor who's willing to try it anyway. Or you can
sue everybody for failure to provide care.

Here's a patient whose heart probably isn't up to the extra load of
hemodialysis. But their kidneys aren't working. The last time they were
dialyzed they nearly died, but didn't because the technician happened
to know the latest tricks of keeping the blood pressure just right with
the latest machine. But *that* guy's on vacation. So now what? If you
don't dialyze, the patient will surely die. If you do, the next tech
will probably kill them. But maybe not. There you go.

Whatever you do, you're betting a small chance of extending life,
against an extra risk of dying NOW if you operate, or whatever (vs
doing nothing, in which case the patient will surely die during the
hospitalization, but maybe not this second). And if the operation or
procedure or drug kills them, or some problem while delivering it
pushes them over, you can always say they were ROBBED of a few days or
hours or seconds of life.



The Institute of Medicine estimates that over 100,000 patients die
every year in *highly regulated* U.S. hospitals as a result of medical
errors or mistakes?. and beginning in 1999 that dialogue was sold to
the American public in newspaper banners and on TV news programs
across
the nation.



COMMENT:

FROM A MESSAGE POSTED A YEAR AGO (this seems to come up once a year,
while all the doctor bashers are on on vaccation):

S.B.Harris, M.D.

Here is a sad truth of physiology that every physician knows: in any
developed country, most deaths happen in the aged and the otherwise
very infirm, frail, and chronically ill. Such people, as they approach
the day of their deaths, become more and more like a house of cards
which is waiting for that last card of that last puff of wind.
Sometimes what sends them over is a medical error. Often enough, it's
the kind of error that all but the terminally ill would survive. If no
error is made, it's always something else.

Let me pause for an illustrative story. When I was a resident we had
an elderly respiratory patient who always pestered the staff about her
diet. Because she had no dentures, she had been ordered a pureed diet.
That was fine with her, but she couldn't get her favorite food, which
was a boiled egg for breakfast. Each day she demanded a boiled egg,
which the dietary service could not provide on the diet orders she had
writen. Until finally the nurses started calling the housestaff about
it. It was thought that a mechanical soft diet in general would be too
much for the woman, but perhaps an egg could be excepted. So one of my
interns, desiring to increase the quality of the woman's life and to
cut short the infernal complaining, literally wrote the following
medical order on the woman's chart: "Please give pt [patient] boiled
eggs PRN [meaning whenever she likes]."

This was early in the morning. Later in the morning there was a "code"
(an arrested patient) and the code team found that the arrested
patient was the boiled egg lady. The next orders in the chart to be
writen after "Please give pt boiled eggs PRN" were the code medication
orders. And these were the last orders also, because the women did not
survive. The code intern found difficulty intubating the woman through
the remains of boiled egg in her trachea, which she had aspirated.

With the cruel humor of all housestaffs, we spent some time thereafter
whenever we could, remaining the unfortunate intern about how he had
killed the "boiled egg lady" with his boiled egg order. Surely a fatal

medical error.

And now, for some hardboiled abstracts on the subject. Pay attention
particularly to the last one:


==============================­===========


Eff Clin Pract. 2000 Nov-Dec;3(6):277-83.


How many deaths are due to medical error? Getting the number right.
Sox Jr HC, Woloshin S.

Dartmouth Medical School, Hanover, NH, USA. harold.c....@dartmouth.edu

CONTEXT: The Institute of Medicine (IOM) report on medical errors
created an intense public response by stating that between 44,000 and
98,000 hospitalized Americans die each year as a result of preventable
medical errors. OBJECTIVE: To determine how well the IOM committee
documented its estimates and how valid they were. METHODS: We reviewed
the studies cited in the IOM committee's report and related published
articles. RESULTS: The two studies cited by the IOM committee
substantiate its statement that adverse events occur in 2.9% to 3.7% of
hospital admissions. Supporting data for the assertion that about half
of these adverse events are preventable are less clear. In fact, the
original studies
cited did not define preventable adverse events, and the reliability of
subjective judgments about preventability was not formally assessed.
The committee's estimate of the number of preventable deaths due to
medical errors is least substantiated. The methods used to estimate the
upper bound of the estimate (98,000 preventable deaths) were highly
subjective, and their reliability and reproducibility are unknown, as
are the methods used to estimate the lower bound (44,000 deaths).
CONCLUSION: Using the published literature, we could not confirm the
Institute of Medicine's reported number of deaths due to medical
errors. Due to the potential impact of this number on policy, it is
unfortunate that the IOM's estimate is not well substantiated.
Publication Types:
Review
Review, Tutorial
PMID: 11151524 [PubMed - indexed for MEDLINE]



Hosp Case Manag. 2000 Oct;8(10):suppl 3-4, 146.
University study identifies problems with IOM report.
[No authors listed]

The Institute of Medicine's (IOM) report on medical errors is faulty
because it does not include a control group and all the patients
studied were 'very sick' according to researchers at Indiana
University. "What the figures suggest is that people don't die [without
an adverse event]," says Clement J. McDonald, MD, director of the
Regenstrief Institute and Distinguished Professor of Medicine at
Indiana University School of Medicine in Indianapolis. McDonald is
referring to the study released by the IOM of the National Academies in
November that states 'preventable adverse events are a leading cause of
death' and 'at least 44,000 and perhaps as many as 98,000 Americans die
in hospitals each year as a result of medical errors.
PMID: 11143166 [PubMed - indexed for MEDLINE]


========================

Eff Clin Pract. 2000 Nov-Dec;3(6):261-9.

Comment in:
Eff Clin Pract. 2001 May-Jun;4(3):141; author reply 142.
Eff Clin Pract. 2001 May-Jun;4(3):141; author reply 142.

What is an error?
Hofer TP, Kerr EA, Hayward RA.

Department of Veterans Affairs, VA Center for Practice Management and
Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Mich.,
USA.
tho...@umich.edu


CONTEXT: Launched by the Institute of Medicine's report, "To Err is
Human," the reduction of medical errors has become a top agenda item
for virtually every part of the U.S. health care system. OBJECTIVE: To
identify existing definitions of error, to determine the major issues
in measuring errors, and to present recommendations for how best to
proceed. DATA SOURCE: Medical literature on errors as well as the
sociology and industrial psychology literature cited therein. RESULTS:
We have four principal observations. First, errors have been defined in
terms of failed processes without any link to subsequent harm. Second,
only a few studies have actually measured errors, and these have not
described the reliability of the measurement. Third, no studies
directly examine the relationship between errors and adverse events.
Fourth, the value of pursuing latent system errors (a concept
pertaining to small, often trivial structure and process problems that
interact in complex ways to produce catastrophe) using case studies or
root cause analysis has not been demonstrated in either the medical or
nonmedical literature. CONCLUSION: Medical
error should be defined in terms of failed processes that are clearly
linked to adverse outcomes. Efforts to reduce errors should be
proportional to their impact on outcomes (preventable morbidity,
mortality, and patient satisfaction) and the cost of preventing them.
The error and the quality movements are analogous and require the same
rigorous epidemiologic approach to establish which relationships are
causal.
Publication Types:
Review
Review, Tutorial
PMID: 11151522 [PubMed - indexed for MEDLINE]


JAMA. 2001 Jul 25;286(4):415-20.
Comment in:
JAMA. 2001 Dec 12;286(22):2813-4.
Estimating hospital deaths due to medical errors: preventability is in
the eye of the reviewer.
Hayward RA, Hofer TP.

CONTEXT: Studies using physician implicit review have suggested that
the number of deaths due to medical errors in US hospitals is extremely
high. However, some have questioned the validity of these estimates.
OBJECTIVE: To examine the reliability of reviewer ratings of medical
error and the implications of a death described as "preventable by
better care" in terms of the probability of immediate and short-term
survival if care had been optimal. DESIGN: Retrospective implicit
review of medical records from 1995-1996. SETTING AND PARTICIPANTS:
Fourteen board-certified, trained internists used a previously tested
structured implicit review instrument to conduct 383 reviews of 111
hospital deaths at 7 Department of Veterans Affairs medical centers,
oversampling for markers previously found to be associated with high
rates of preventable deaths. Patients considered terminally ill who
received comfort care only were excluded. MAIN OUTCOME MEASURES:
Reviewer estimates of
whether deaths could have been prevented by optimal care (rated on a
5-point scale) and of the probability that patients would have lived to
discharge or for 3 months or more if care had been optimal (rated from
0%-100%). RESULTS: Similar to previous studies, almost a quarter
(22.7%) of active-care patient deaths were rated as at least possibly
preventable by optimal care, with 6.0% rated as probably or definitely
preventable. Interrater reliability for these ratings was also similar
to previous studies (0.34 for 2 reviewers). The reviewers' estimates of
the percentage of patients who would have left the hospital alive had
optimal care been provided was 6.0% (95% confidence interval [CI],
3.4%-8.6%).However, after considering 3-month prognosis and adjusting
for the variability and skewness of reviewers' ratings, clinicians
estimated that only 0.5% (95% CI, 0.3%-0.7%) of patients who died would
have lived 3 months or more in good cognitive health if care had been
optimal, representing roughly 1 patient per 10 000 admissions to the
study hospitals. CONCLUSIONS: Medical errors are a major concern
regardless of patients' life expectancies, but our study suggests that
previous interpretations of medical error statistics are probably
misleading. Our data place the estimates of preventable deaths in
context, pointing out the limitations of this means of identifying
medical errors and assessing their potential implications for patient
outcomes.

PMID: 11466119 [PubMed - indexed for MEDLINE]
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Quintal
medicine forum beginner


Joined: 23 Jun 2005
Posts: 7

PostPosted: Sat Jul 30, 2005 6:32 pm    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

On 26 Jul 2005 23:38:27 -0700, dcholiman@ev1.net wrote:

Quote:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Flawed logic here. Accidental prescription side effect
deaths may exceed accidental gun deaths per year.
But total gun death far exceeds total overdose death
from whatever the drug source.
"Guns kill people, drugs kill pain."
David H
~~~~~~~~~~~~~~~~~~~~

what does overdose have to do with this argument?
It's about the risk of being treated by a doctor. As another poster
noted, it should be taken into account the supposed risk of NOT being
treated by a doctor, if there is one, for the argument that I
presented to be proven valid.
But overdose? What's the logic there?
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Quintal
medicine forum beginner


Joined: 23 Jun 2005
Posts: 7

PostPosted: Sat Jul 30, 2005 6:29 pm    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

On Sun, 24 Jul 2005 20:20:19 +0200, "Eataine"
<eataine@PASDEPUBnetcourrier.com> wrote:

Quote:
Bon, allez, tant pis...

Primo, il faut comparer le nombre d'actes médicaux et non pas le nombre de
médecins... Un dermatologue a moins de "chances" d'avoir un décés à son
actif qu'un urgentiste, un cardiologue ou un oncologue...

Secundo, dans les décès accidentels dus aux médecins, combien seraient
arrivés en l'absence d'intervention du médecins?


Tertio, pas la peine d'aller plus loin, on reconnait bien là la plume de
quintal... Un bon quintal de connerie...

Après cette faible tentative d'argumentation, ton attaque personnelle
est comique (quoique c'est plus facile mdr, quand on n'arrive pas à
démontrer quelque chose, il y a toujours le refuge d'attaquer le
posteur mdr).

Peut mieux faire!

Quote:

Fred

"Quintal" <xavier22@ZEGJEROGclub-internet.fr> a écrit dans le message de
news: 9ah5e1d3ul9bgbfdh1kqdnef3titassvqr@4ax.com...
US Gun Statistics
Various Sources
2-2-5


(A) The number of physicians in the U.S. is 700,000.
(B) Accidental deaths caused by Physicians per year are 120,000.
(C) Accidental deaths per physician is 0.171.

(Statistics courtesy of U.S. Dept. of Health Human Services)

Guns
(A) The number of gun owners in the U.S. is 80,000,000.
Yes, that is 80 million.

(B) The number of accidental gun deaths per year, all age groups, is
1,500.
(C) The number of accidental deaths per gun owner is 0.000188.

Statistically, doctors are approximately 9,000 times more dangerous
than gun owners.
Remember, "Guns don't kill people, doctors do."

FACT: NOT EVERYONE HAS A GUN, BUT ALMOST EVERYONE HAS AT LEAST ONE
DOCTOR.

Please alert your friends to this alarming threat. We must ban doctors
before this gets completely out of hand!

Out of concern for the public at large, I have withheld the statistics
on lawyers for fear the shock would cause people to panic and seek
medical attention.


--
francom.esoterisme,sci.med,fr.bio.medecine,alt.conspiracy
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Terri
medicine forum beginner


Joined: 28 Jun 2005
Posts: 35

PostPosted: Thu Jul 28, 2005 5:40 pm    Post subject: Re: Med Errors and Hard-Boiled Defective Stories (Re: Guns dont kill people, doctors do.) Reply with quote

Sbharris[atsign]ix.netcom.com wrote:
Quote:
No. It was based on the numbers of people who died *of* the medical
error/accident.

COMMENT:

Repeating it won't make it so. THERE WAS NO CONTROL GROUP.


Quote:
And without
one, you cannot TELL who died OF the medical error (usually).

Saying *that* won't make it so. Many medical errors are blatant and
they are often obviously the proximate cause of death. All medical
errors are not doctor-caused btw. Nurses make their share.

I'm not doctor-bashing.

Quote:
All you
can tell is that they died AFTER it, and take your best GUESS as to
whether or not this very ill person would have made it, if the error
had not occurred. I've appended a number of abstracts pointing out all
this out, and even one in which the doctors actually tried to do a best
guess as to whether or not error made in hospitals were indeed fatal,
using the baseline that the patient would otherwise would be expected
to have left the hospital and lived another three months.

So if the patient would have been expected to die within three months
of the error of his/her underlying disease anyway, the medical error
didn't cause the death or it doesn't count? I don't think so.
Quote:

Remember, please, that as patients who are dying of cancer or old age
or some chronic disease become more and more frail, they become more
and more like a house of cards with too many cards. It becomes more and
more difficult to do ANYTHING for them without small imperfections in
your technique causing possibly major problems. Or to put it another
way, getting them to live through any interventive procedure takes
greater and greater skill until finally you hit the wall where only the
best surgeon or intensivist on the planet *might* be able to get them
through the next infection or stint on the ventilator or surgical
procedure (which they need to survive another couple of weeks) but that
person isn't available. That's *how* people often die if you have no
hospice and nobody is willing to "give up." Sorry. And you can always
witchhunt and find somebody to blame. Indeed, if the doctors refuse to
do anything, knowing that doing anything will probably be useless
and/or carry a high degree of causing yet more problems, you can always
fire them and find a doctor who's willing to try it anyway. Or you can
sue everybody for failure to provide care.

Here's a patient whose heart probably isn't up to the extra load of
hemodialysis. But their kidneys aren't working. The last time they were
dialyzed they nearly died, but didn't because the technician happened
to know the latest tricks of keeping the blood pressure just right with
the latest machine. But *that* guy's on vacation. So now what? If you
don't dialyze, the patient will surely die. If you do, the next tech
will probably kill them. But maybe not. There you go.

Whatever you do, you're betting a small chance of extending life,
against an extra risk of dying NOW if you operate, or whatever (vs
doing nothing, in which case the patient will surely die during the
hospitalization, but maybe not this second). And if the operation or
procedure or drug kills them, or some problem while delivering it
pushes them over, you can always say they were ROBBED of a few days or
hours or seconds of life.



The Institute of Medicine estimates that over 100,000 patients die
every year in *highly regulated* U.S. hospitals as a result of medical
errors or mistakes?. and beginning in 1999 that dialogue was sold to
the American public in newspaper banners and on TV news programs
across
the nation.



COMMENT:

FROM A MESSAGE POSTED A YEAR AGO (this seems to come up once a year,
while all the doctor bashers are on on vaccation):

S.B.Harris, M.D.

Here is a sad truth of physiology that every physician knows: in any
developed country, most deaths happen in the aged and the otherwise
very infirm, frail, and chronically ill. Such people, as they approach
the day of their deaths, become more and more like a house of cards
which is waiting for that last card of that last puff of wind.
Sometimes what sends them over is a medical error. Often enough, it's
the kind of error that all but the terminally ill would survive. If no
error is made, it's always something else.

Let me pause for an illustrative story. When I was a resident we had
an elderly respiratory patient who always pestered the staff about her
diet. Because she had no dentures, she had been ordered a pureed diet.
That was fine with her, but she couldn't get her favorite food, which
was a boiled egg for breakfast. Each day she demanded a boiled egg,
which the dietary service could not provide on the diet orders she had
writen. Until finally the nurses started calling the housestaff about
it. It was thought that a mechanical soft diet in general would be too
much for the woman, but perhaps an egg could be excepted. So one of my
interns, desiring to increase the quality of the woman's life and to
cut short the infernal complaining, literally wrote the following
medical order on the woman's chart: "Please give pt [patient] boiled
eggs PRN [meaning whenever she likes]."

This was early in the morning. Later in the morning there was a "code"
(an arrested patient) and the code team found that the arrested
patient was the boiled egg lady. The next orders in the chart to be
writen after "Please give pt boiled eggs PRN" were the code medication
orders. And these were the last orders also, because the women did not
survive. The code intern found difficulty intubating the woman through
the remains of boiled egg in her trachea, which she had aspirated.

With the cruel humor of all housestaffs, we spent some time thereafter
whenever we could, remaining the unfortunate intern about how he had
killed the "boiled egg lady" with his boiled egg order. Surely a fatal

medical error.

And now, for some hardboiled abstracts on the subject. Pay attention
particularly to the last one:


==============================­==========

Eff Clin Pract. 2000 Nov-Dec;3(6):277-83.


How many deaths are due to medical error? Getting the number right.
Sox Jr HC, Woloshin S.

Dartmouth Medical School, Hanover, NH, USA. harold.c....@dartmouth.edu

CONTEXT: The Institute of Medicine (IOM) report on medical errors
created an intense public response by stating that between 44,000 and
98,000 hospitalized Americans die each year as a result of preventable
medical errors. OBJECTIVE: To determine how well the IOM committee
documented its estimates and how valid they were. METHODS: We reviewed
the studies cited in the IOM committee's report and related published
articles. RESULTS: The two studies cited by the IOM committee
substantiate its statement that adverse events occur in 2.9% to 3.7% of
hospital admissions. Supporting data for the assertion that about half
of these adverse events are preventable are less clear. In fact, the
original studies
cited did not define preventable adverse events, and the reliability of
subjective judgments about preventability was not formally assessed.
The committee's estimate of the number of preventable deaths due to
medical errors is least substantiated. The methods used to estimate the
upper bound of the estimate (98,000 preventable deaths) were highly
subjective, and their reliability and reproducibility are unknown, as
are the methods used to estimate the lower bound (44,000 deaths).
CONCLUSION: Using the published literature, we could not confirm the
Institute of Medicine's reported number of deaths due to medical
errors. Due to the potential impact of this number on policy, it is
unfortunate that the IOM's estimate is not well substantiated.
Publication Types:
Review
Review, Tutorial
PMID: 11151524 [PubMed - indexed for MEDLINE]



Hosp Case Manag. 2000 Oct;8(10):suppl 3-4, 146.
University study identifies problems with IOM report.
[No authors listed]

The Institute of Medicine's (IOM) report on medical errors is faulty
because it does not include a control group and all the patients
studied were 'very sick' according to researchers at Indiana
University. "What the figures suggest is that people don't die [without
an adverse event]," says Clement J. McDonald, MD, director of the
Regenstrief Institute and Distinguished Professor of Medicine at
Indiana University School of Medicine in Indianapolis. McDonald is
referring to the study released by the IOM of the National Academies in
November that states 'preventable adverse events are a leading cause of
death' and 'at least 44,000 and perhaps as many as 98,000 Americans die
in hospitals each year as a result of medical errors.
PMID: 11143166 [PubMed - indexed for MEDLINE]


=======================
Eff Clin Pract. 2000 Nov-Dec;3(6):261-9.

Comment in:
Eff Clin Pract. 2001 May-Jun;4(3):141; author reply 142.
Eff Clin Pract. 2001 May-Jun;4(3):141; author reply 142.

What is an error?
Hofer TP, Kerr EA, Hayward RA.

Department of Veterans Affairs, VA Center for Practice Management and
Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Mich.,
USA.
tho...@umich.edu


CONTEXT: Launched by the Institute of Medicine's report, "To Err is
Human," the reduction of medical errors has become a top agenda item
for virtually every part of the U.S. health care system. OBJECTIVE: To
identify existing definitions of error, to determine the major issues
in measuring errors, and to present recommendations for how best to
proceed. DATA SOURCE: Medical literature on errors as well as the
sociology and industrial psychology literature cited therein. RESULTS:
We have four principal observations. First, errors have been defined in
terms of failed processes without any link to subsequent harm. Second,
only a few studies have actually measured errors, and these have not
described the reliability of the measurement. Third, no studies
directly examine the relationship between errors and adverse events.
Fourth, the value of pursuing latent system errors (a concept
pertaining to small, often trivial structure and process problems that
interact in complex ways to produce catastrophe) using case studies or
root cause analysis has not been demonstrated in either the medical or
nonmedical literature. CONCLUSION: Medical
error should be defined in terms of failed processes that are clearly
linked to adverse outcomes. Efforts to reduce errors should be
proportional to their impact on outcomes (preventable morbidity,
mortality, and patient satisfaction) and the cost of preventing them.
The error and the quality movements are analogous and require the same
rigorous epidemiologic approach to establish which relationships are
causal.
Publication Types:
Review
Review, Tutorial
PMID: 11151522 [PubMed - indexed for MEDLINE]


JAMA. 2001 Jul 25;286(4):415-20.
Comment in:
JAMA. 2001 Dec 12;286(22):2813-4.
Estimating hospital deaths due to medical errors: preventability is in
the eye of the reviewer.
Hayward RA, Hofer TP.

CONTEXT: Studies using physician implicit review have suggested that
the number of deaths due to medical errors in US hospitals is extremely
high. However, some have questioned the validity of these estimates.
OBJECTIVE: To examine the reliability of reviewer ratings of medical
error and the implications of a death described as "preventable by
better care" in terms of the probability of immediate and short-term
survival if care had been optimal. DESIGN: Retrospective implicit
review of medical records from 1995-1996. SETTING AND PARTICIPANTS:
Fourteen board-certified, trained internists used a previously tested
structured implicit review instrument to conduct 383 reviews of 111
hospital deaths at 7 Department of Veterans Affairs medical centers,
oversampling for markers previously found to be associated with high
rates of preventable deaths. Patients considered terminally ill who
received comfort care only were excluded. MAIN OUTCOME MEASURES:
Reviewer estimates of
whether deaths could have been prevented by optimal care (rated on a
5-point scale) and of the probability that patients would have lived to
discharge or for 3 months or more if care had been optimal (rated from
0%-100%). RESULTS: Similar to previous studies, almost a quarter
(22.7%) of active-care patient deaths were rated as at least possibly
preventable by optimal care, with 6.0% rated as probably or definitely
preventable. Interrater reliability for these ratings was also similar
to previous studies (0.34 for 2 reviewers). The reviewers' estimates of
the percentage of patients who would have left the hospital alive had
optimal care been provided was 6.0% (95% confidence interval [CI],
3.4%-8.6%).However, after considering 3-month prognosis and adjusting
for the variability and skewness of reviewers' ratings, clinicians
estimated that only 0.5% (95% CI, 0.3%-0.7%) of patients who died would
have lived 3 months or more in good cognitive health if care had been
optimal, representing roughly 1 patient per 10 000 admissions to the
study hospitals. CONCLUSIONS: Medical errors are a major concern
regardless of patients' life expectancies, but our study suggests that
previous interpretations of medical error statistics are probably
misleading. Our data place the estimates of preventable deaths in
context, pointing out the limitations of this means of identifying
medical errors and assessing their potential implications for patient
outcomes.

PMID: 11466119 [PubMed - indexed for MEDLINE]
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Sbharris[atsign]ix.netcom
medicine forum Guru


Joined: 28 Apr 2005
Posts: 1218

PostPosted: Thu Jul 28, 2005 5:07 pm    Post subject: Med Errors and Hard-Boiled Defective Stories (Re: Guns dont kill people, doctors do.) Reply with quote

Quote:
No. It was based on the numbers of people who died *of* the medical
error/accident.

COMMENT:

Repeating it won't make it so. THERE WAS NO CONTROL GROUP. And without
one, you cannot TELL who died OF the medical error (usually). All you
can tell is that they died AFTER it, and take your best GUESS as to
whether or not this very ill person would have made it, if the error
had not occurred. I've appended a number of abstracts pointing out all
this out, and even one in which the doctors actually tried to do a best
guess as to whether or not error made in hospitals were indeed fatal,
using the baseline that the patient would otherwise would be expected
to have left the hospital and lived another three months.

Remember, please, that as patients who are dying of cancer or old age
or some chronic disease become more and more frail, they become more
and more like a house of cards with too many cards. It becomes more and
more difficult to do ANYTHING for them without small imperfections in
your technique causing possibly major problems. Or to put it another
way, getting them to live through any interventive procedure takes
greater and greater skill until finally you hit the wall where only the
best surgeon or intensivist on the planet *might* be able to get them
through the next infection or stint on the ventilator or surgical
procedure (which they need to survive another couple of weeks) but that
person isn't available. That's *how* people often die if you have no
hospice and nobody is willing to "give up." Sorry. And you can always
witchhunt and find somebody to blame. Indeed, if the doctors refuse to
do anything, knowing that doing anything will probably be useless
and/or carry a high degree of causing yet more problems, you can always
fire them and find a doctor who's willing to try it anyway. Or you can
sue everybody for failure to provide care.

Here's a patient whose heart probably isn't up to the extra load of
hemodialysis. But their kidneys aren't working. The last time they were
dialyzed they nearly died, but didn't because the technician happened
to know the latest tricks of keeping the blood pressure just right with
the latest machine. But *that* guy's on vacation. So now what? If you
don't dialyze, the patient will surely die. If you do, the next tech
will probably kill them. But maybe not. There you go.

Whatever you do, you're betting a small chance of extending life,
against an extra risk of dying NOW if you operate, or whatever (vs
doing nothing, in which case the patient will surely die during the
hospitalization, but maybe not this second). And if the operation or
procedure or drug kills them, or some problem while delivering it
pushes them over, you can always say they were ROBBED of a few days or
hours or seconds of life.



Quote:
The Institute of Medicine estimates that over 100,000 patients die
every year in *highly regulated* U.S. hospitals as a result of medical
errors or mistakes?. and beginning in 1999 that dialogue was sold to
the American public in newspaper banners and on TV news programs
across
the nation.



COMMENT:

FROM A MESSAGE POSTED A YEAR AGO (this seems to come up once a year,
while all the doctor bashers are on on vaccation):

S.B.Harris, M.D.

Here is a sad truth of physiology that every physician knows: in any
developed country, most deaths happen in the aged and the otherwise
very infirm, frail, and chronically ill. Such people, as they approach
the day of their deaths, become more and more like a house of cards
which is waiting for that last card of that last puff of wind.
Sometimes what sends them over is a medical error. Often enough, it's
the kind of error that all but the terminally ill would survive. If no
error is made, it's always something else.

Let me pause for an illustrative story. When I was a resident we had
an elderly respiratory patient who always pestered the staff about her
diet. Because she had no dentures, she had been ordered a pureed diet.
That was fine with her, but she couldn't get her favorite food, which
was a boiled egg for breakfast. Each day she demanded a boiled egg,
which the dietary service could not provide on the diet orders she had
writen. Until finally the nurses started calling the housestaff about
it. It was thought that a mechanical soft diet in general would be too
much for the woman, but perhaps an egg could be excepted. So one of my
interns, desiring to increase the quality of the woman's life and to
cut short the infernal complaining, literally wrote the following
medical order on the woman's chart: "Please give pt [patient] boiled
eggs PRN [meaning whenever she likes]."

This was early in the morning. Later in the morning there was a "code"
(an arrested patient) and the code team found that the arrested
patient was the boiled egg lady. The next orders in the chart to be
writen after "Please give pt boiled eggs PRN" were the code medication
orders. And these were the last orders also, because the women did not
survive. The code intern found difficulty intubating the woman through
the remains of boiled egg in her trachea, which she had aspirated.

With the cruel humor of all housestaffs, we spent some time thereafter
whenever we could, remaining the unfortunate intern about how he had
killed the "boiled egg lady" with his boiled egg order. Surely a fatal

medical error.

And now, for some hardboiled abstracts on the subject. Pay attention
particularly to the last one:


==============================­==========

Eff Clin Pract. 2000 Nov-Dec;3(6):277-83.


How many deaths are due to medical error? Getting the number right.
Sox Jr HC, Woloshin S.

Dartmouth Medical School, Hanover, NH, USA. harold.c....@dartmouth.edu

CONTEXT: The Institute of Medicine (IOM) report on medical errors
created an intense public response by stating that between 44,000 and
98,000 hospitalized Americans die each year as a result of preventable
medical errors. OBJECTIVE: To determine how well the IOM committee
documented its estimates and how valid they were. METHODS: We reviewed
the studies cited in the IOM committee's report and related published
articles. RESULTS: The two studies cited by the IOM committee
substantiate its statement that adverse events occur in 2.9% to 3.7% of
hospital admissions. Supporting data for the assertion that about half
of these adverse events are preventable are less clear. In fact, the
original studies
cited did not define preventable adverse events, and the reliability of
subjective judgments about preventability was not formally assessed.
The committee's estimate of the number of preventable deaths due to
medical errors is least substantiated. The methods used to estimate the
upper bound of the estimate (98,000 preventable deaths) were highly
subjective, and their reliability and reproducibility are unknown, as
are the methods used to estimate the lower bound (44,000 deaths).
CONCLUSION: Using the published literature, we could not confirm the
Institute of Medicine's reported number of deaths due to medical
errors. Due to the potential impact of this number on policy, it is
unfortunate that the IOM's estimate is not well substantiated.
Publication Types:
Review
Review, Tutorial
PMID: 11151524 [PubMed - indexed for MEDLINE]



Hosp Case Manag. 2000 Oct;8(10):suppl 3-4, 146.
University study identifies problems with IOM report.
[No authors listed]

The Institute of Medicine's (IOM) report on medical errors is faulty
because it does not include a control group and all the patients
studied were 'very sick' according to researchers at Indiana
University. "What the figures suggest is that people don't die [without
an adverse event]," says Clement J. McDonald, MD, director of the
Regenstrief Institute and Distinguished Professor of Medicine at
Indiana University School of Medicine in Indianapolis. McDonald is
referring to the study released by the IOM of the National Academies in
November that states 'preventable adverse events are a leading cause of
death' and 'at least 44,000 and perhaps as many as 98,000 Americans die
in hospitals each year as a result of medical errors.
PMID: 11143166 [PubMed - indexed for MEDLINE]


=======================
Eff Clin Pract. 2000 Nov-Dec;3(6):261-9.

Comment in:
Eff Clin Pract. 2001 May-Jun;4(3):141; author reply 142.
Eff Clin Pract. 2001 May-Jun;4(3):141; author reply 142.

What is an error?
Hofer TP, Kerr EA, Hayward RA.

Department of Veterans Affairs, VA Center for Practice Management and
Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Mich.,
USA.
tho...@umich.edu


CONTEXT: Launched by the Institute of Medicine's report, "To Err is
Human," the reduction of medical errors has become a top agenda item
for virtually every part of the U.S. health care system. OBJECTIVE: To
identify existing definitions of error, to determine the major issues
in measuring errors, and to present recommendations for how best to
proceed. DATA SOURCE: Medical literature on errors as well as the
sociology and industrial psychology literature cited therein. RESULTS:
We have four principal observations. First, errors have been defined in
terms of failed processes without any link to subsequent harm. Second,
only a few studies have actually measured errors, and these have not
described the reliability of the measurement. Third, no studies
directly examine the relationship between errors and adverse events.
Fourth, the value of pursuing latent system errors (a concept
pertaining to small, often trivial structure and process problems that
interact in complex ways to produce catastrophe) using case studies or
root cause analysis has not been demonstrated in either the medical or
nonmedical literature. CONCLUSION: Medical
error should be defined in terms of failed processes that are clearly
linked to adverse outcomes. Efforts to reduce errors should be
proportional to their impact on outcomes (preventable morbidity,
mortality, and patient satisfaction) and the cost of preventing them.
The error and the quality movements are analogous and require the same
rigorous epidemiologic approach to establish which relationships are
causal.
Publication Types:
Review
Review, Tutorial
PMID: 11151522 [PubMed - indexed for MEDLINE]


JAMA. 2001 Jul 25;286(4):415-20.
Comment in:
JAMA. 2001 Dec 12;286(22):2813-4.
Estimating hospital deaths due to medical errors: preventability is in
the eye of the reviewer.
Hayward RA, Hofer TP.

CONTEXT: Studies using physician implicit review have suggested that
the number of deaths due to medical errors in US hospitals is extremely
high. However, some have questioned the validity of these estimates.
OBJECTIVE: To examine the reliability of reviewer ratings of medical
error and the implications of a death described as "preventable by
better care" in terms of the probability of immediate and short-term
survival if care had been optimal. DESIGN: Retrospective implicit
review of medical records from 1995-1996. SETTING AND PARTICIPANTS:
Fourteen board-certified, trained internists used a previously tested
structured implicit review instrument to conduct 383 reviews of 111
hospital deaths at 7 Department of Veterans Affairs medical centers,
oversampling for markers previously found to be associated with high
rates of preventable deaths. Patients considered terminally ill who
received comfort care only were excluded. MAIN OUTCOME MEASURES:
Reviewer estimates of
whether deaths could have been prevented by optimal care (rated on a
5-point scale) and of the probability that patients would have lived to
discharge or for 3 months or more if care had been optimal (rated from
0%-100%). RESULTS: Similar to previous studies, almost a quarter
(22.7%) of active-care patient deaths were rated as at least possibly
preventable by optimal care, with 6.0% rated as probably or definitely
preventable. Interrater reliability for these ratings was also similar
to previous studies (0.34 for 2 reviewers). The reviewers' estimates of
the percentage of patients who would have left the hospital alive had
optimal care been provided was 6.0% (95% confidence interval [CI],
3.4%-8.6%).However, after considering 3-month prognosis and adjusting
for the variability and skewness of reviewers' ratings, clinicians
estimated that only 0.5% (95% CI, 0.3%-0.7%) of patients who died would
have lived 3 months or more in good cognitive health if care had been
optimal, representing roughly 1 patient per 10 000 admissions to the
study hospitals. CONCLUSIONS: Medical errors are a major concern
regardless of patients' life expectancies, but our study suggests that
previous interpretations of medical error statistics are probably
misleading. Our data place the estimates of preventable deaths in
context, pointing out the limitations of this means of identifying
medical errors and assessing their potential implications for patient
outcomes.

PMID: 11466119 [PubMed - indexed for MEDLINE]
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Terri
medicine forum beginner


Joined: 28 Jun 2005
Posts: 35

PostPosted: Thu Jul 28, 2005 12:07 pm    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

Quintal wrote:
Quote:
On 23 Jul 2005 15:42:53 -0700, "Sbharris[atsign]ix.netcom.com"
sbharris@ix.netcom.com> wrote:



Quintal wrote:
US Gun Statistics
Various Sources
2-2-5


(A) The number of physicians in the U.S. is 700,000.
(B) Accidental deaths caused by Physicians per year are 120,000.



Wrong. There is no good evidence for the last statistic. It was
generated in studies in which ALL deaths of ill people in hospitals to
whom accidents happened, where presumed due to the medical accidents.
Which amounts to asssuming that those ill people in hospitals to whom
medical accidents do NOT happen, are immortal. Wups.

No. It was based on the numbers of people who died *of* the medical
error/accident. The risk of death to any human being is 100%. None of
us are going to get out of here alive. But for these people death was
untimely, whether it was 1 minute earlier or years earlier, these
people were cheated out of whatever life they had left by a medical
accident.


Quote:

good counter-point, thank you.
anyway the above quoted text was not mean at all by its author to be a
charge against medicine. I mischievously posted it to medical NGs;-)
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95 Thesen
medicine forum beginner


Joined: 28 May 2005
Posts: 48

PostPosted: Wed Jul 27, 2005 4:38 am    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Flawed logic here. Accidental prescription side effect
deaths may exceed accidental gun deaths per year.
But total gun death far exceeds total overdose death
from whatever the drug source.
"Guns kill people, drugs kill pain."
David H
~~~~~~~~~~~~~~~~~~~~
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PostPosted: Sun Jul 24, 2005 5:12 am    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

Do you have any evidence for this claim?

I believe the the studies refered to by the IOM determined and
did not presume that the deaths were caused by errors.
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HCN
medicine forum Guru Wannabe


Joined: 15 May 2005
Posts: 139

PostPosted: Sun Jul 24, 2005 2:14 am    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

....WAIT... according to this:
http://www.disastercenter.com/cdc/ ... auto accidents kill more than
ANYthing, up until age 45. Then AFTER age 45 diseases like malignant
neoplasms and diseases of the heart barely beat auto accidents.

How about we outlaw CARS! (or just no give driver's licenses to anyone
under the age of 45)
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Bob
medicine forum beginner


Joined: 15 Jun 2005
Posts: 25

PostPosted: Sun Jul 24, 2005 12:13 am    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

On Sat, 23 Jul 2005 22:30:05 GMT, Quintal
<xavier22@ZEGJEROGclub-internet.fr> wrote:

Quote:
US Gun Statistics
Various Sources
2-2-5


(A) The number of physicians in the U.S. is 700,000.
(B) Accidental deaths caused by Physicians per year are 120,000.
(C) Accidental deaths per physician is 0.171.

(Statistics courtesy of U.S. Dept. of Health Human Services)

Guns
(A) The number of gun owners in the U.S. is 80,000,000.
Yes, that is 80 million.

(B) The number of accidental gun deaths per year, all age groups, is
1,500.
(C) The number of accidental deaths per gun owner is 0.000188.

Statistically, doctors are approximately 9,000 times more dangerous
than gun owners.
Remember, "Guns don't kill people, doctors do."

Amazing what one can do with statistics.


You should normalize your data for the number of encounters.
Probability of death per encounter with a doc or a gun would be more
useful.


(I've read your exchange with SBH.)


bob
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Quintal
medicine forum beginner


Joined: 23 Jun 2005
Posts: 7

PostPosted: Sat Jul 23, 2005 8:53 pm    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

On 23 Jul 2005 15:42:53 -0700, "Sbharris[atsign]ix.netcom.com"
<sbharris@ix.netcom.com> wrote:

Quote:


Quintal wrote:
US Gun Statistics
Various Sources
2-2-5


(A) The number of physicians in the U.S. is 700,000.
(B) Accidental deaths caused by Physicians per year are 120,000.



Wrong. There is no good evidence for the last statistic. It was
generated in studies in which ALL deaths of ill people in hospitals to
whom accidents happened, where presumed due to the medical accidents.
Which amounts to asssuming that those ill people in hospitals to whom
medical accidents do NOT happen, are immortal. Wups.

good counter-point, thank you.
anyway the above quoted text was not mean at all by its author to be a
charge against medicine. I mischievously posted it to medical NGs;-)
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Sbharris[atsign]ix.netcom
medicine forum Guru


Joined: 28 Apr 2005
Posts: 1218

PostPosted: Sat Jul 23, 2005 8:42 pm    Post subject: Re: Guns dont kill people, doctors do. Reply with quote

Quintal wrote:
Quote:
US Gun Statistics
Various Sources
2-2-5


(A) The number of physicians in the U.S. is 700,000.
(B) Accidental deaths caused by Physicians per year are 120,000.



Wrong. There is no good evidence for the last statistic. It was
generated in studies in which ALL deaths of ill people in hospitals to
whom accidents happened, where presumed due to the medical accidents.
Which amounts to asssuming that those ill people in hospitals to whom
medical accidents do NOT happen, are immortal. Wups.
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Quintal
medicine forum beginner


Joined: 23 Jun 2005
Posts: 7

PostPosted: Sat Jul 23, 2005 8:30 pm    Post subject: Guns dont kill people, doctors do. Reply with quote

US Gun Statistics
Various Sources
2-2-5


(A) The number of physicians in the U.S. is 700,000.
(B) Accidental deaths caused by Physicians per year are 120,000.
(C) Accidental deaths per physician is 0.171.

(Statistics courtesy of U.S. Dept. of Health Human Services)

Guns
(A) The number of gun owners in the U.S. is 80,000,000.
Yes, that is 80 million.

(B) The number of accidental gun deaths per year, all age groups, is
1,500.
(C) The number of accidental deaths per gun owner is 0.000188.

Statistically, doctors are approximately 9,000 times more dangerous
than gun owners.
Remember, "Guns don't kill people, doctors do."

FACT: NOT EVERYONE HAS A GUN, BUT ALMOST EVERYONE HAS AT LEAST ONE
DOCTOR.

Please alert your friends to this alarming threat. We must ban doctors
before this gets completely out of hand!

Out of concern for the public at large, I have withheld the statistics
on lawyers for fear the shock would cause people to panic and seek
medical attention.


--
francom.esoterisme,sci.med,fr.bio.medecine,alt.conspiracy
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