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A Second Look Blog

Why Second Opinions Matter

Second opinions and over-reads are vastly helpful in preventing misdiagnoses and mistreatment

A study by researchers at Johns Hopkins Medicine says medical errors should rank as the third leading cause of death in the United States — and highlights how shortcomings in tracking vital statistics are keeping the problem out of the public eye.

The authors cry for changes in death certificates to better tabulate fatal lapses in care. They recommend the Centers for Disease Control (CDC) and Prevention to immediately add medical errors to its annual list reporting the top causes of death.

Based on an analysis of prior research, the Johns Hopkins study estimates that more than 250,000 Americans die each year from medical errors. On the CDC's official list, that would rank only behind heart disease and cancer, which each took about 600,000 lives in 2014.

Medical mistakes that can lead to death range from diagnostic errors to inappropriate doses or types of medications patients receive.

The truly scary thing is that no one really knows the exact toll taken by medical errors. This is because our current coding system doesn’t capture errors such as misdiagnoses.

This analysis was published Tuesday in The BMJ, formerly the British Medical Journal.

Bob Anderson, chief of the mortality statistics branch for the CDC, disputes some of the paper and states that international standards are upheld when it comes to reporting and that change would require an overabundance of data.

However, what Mr. Anderson does not express is that many other medically advanced countries have already put in fail-safes to try and prevent such errors with second opinions being offered at over-reads of medical images and other similar workflows.

The Johns Hopkins authors said the inability to capture the full impact of medical errors results in a lack of public attention.

"While no method of investigating and documenting preventable harm is perfect," the authors write, "some form of data collection of death due to medical error is needed to address the problem."

Anderson, however, said it's an "uncomfortable situation" for a doctor to report that a patient died from a medical error. Adding a check box to the death certificate won't solve that problem, he said, and a better strategy is to educate doctors about the importance of reporting errors.

"This is a public health issue, and they need to report it for the sake of public health," he said.

Dr. Tejal Gandhi, president of the National Patient Safety Foundation, said her organization refers to patient harm as the third leading cause of death.

"If you ask the public about patient safety most people don't really know about it," she said. "If you ask them the top causes of death, most people wouldn't say 'preventable harm.' "

Dr. Eric Thomas, a professor of medicine at the University of Texas Houston Medical School whose research was cited in the Institute of Medicine's landmark To Err is Human report, said "If we can clarify for the public and lawmakers how big a problem these errors are," he said, "you would hope it would lead to more resources toward patient safety."

What the authors and others do not address is that other countries are way ahead of the USA when it comes to trying to prevent these harms to our patients.  Second opinions and over-reads are vastly helpful in preventing misdiagnoses and mistreatment.   This is the solution for this opaque need in our healthcare system.  The time for change is now.  We as patient advocates can and must make a difference, to first do no harm.