What’s the real story on medical negligence?



December 4, 2019 - 9:33 AM

Dear Dr. Roach: A 2016 Hopkins study reported that medical negligence accounts for 250,000 deaths per year. And that’s just mortality; it does not include any contributions to living with disease. My own view is to attribute nearly all of this to the fact that physicians are severely overworked. What do you think about all of this? — R.A.


Answer: I think that the 250,000 figure is not believable. The study looked at in-hospital deaths, which would mean that over a third and perhaps half of all in-hospital deaths are due to medical negligence. That just isn’t reasonable. While I will certainly admit that medical errors and negligence are an important cause of death, which must be (and has been) scrutinized so these deaths can be avoided, other studies have found much different results. A 2019 study with a very powerful design from the University of Washington found that just over 1% of deaths are due to medical error, but that medical error contributed to 2.7% of all deaths. This is still far too many; however, it is much less than the Hopkins study suggested. Not surprisingly, the study showed that it is primarily older individuals at risk from medical error.

Importantly, the rate of mortality due to medical error fell over the time period, reflecting the work that has gone into reducing medical errors. Increasing the number of physicians may help. There are certainly areas in North America with physician shortages, particularly primary care doctors.

However, medical errors are often the result of systems errors. In my opinion, we need systems solutions to further reduce the risk of medical error. This will be more important than having more primary care doctors, partly because medical errors leading to deaths happen more often in the hospital, where primary care doctors are largely replaced by a number of specialty positions, like hospitalists, intensivists and other inpatient medicine specialists.

DEAR DR. ROACH: What do doctors think of tattoos? Are any of the inks used likely to produce cancer? Do tattoos make cancers harder to find on skin? — D.W.

ANSWER: Some of the inks used for tattoos have been classified as carcinogenic (cancer-causing) or possibly carcinogenic. In theory, tattoos could make cancers harder to find. However, the data suggest that the risk appears to be small. Extensive literature searches found only 64 reported cases of skin cancer arising in tattoos from 1938 to 2018, which suggests the risk is no greater than the risk in a person without tattoos.

There are trends toward larger and darker tattoos now, with some people opting for “blackout” tattoos, which turn an entire body part (usually the upper arm) completely black. This type of tattoo would certainly make finding a cancer, or a precancerous lesion that might be removed before becoming a cancer, more challenging.

What do doctors think? It depends on the doctor, but the health risk of tattoos is small when professional tattoo artists follow correct technique, since infection has traditionally been the biggest health risk. Skin reactions to the metals used in tattoo ink are well-described, which is probably the next most common health risk. These risks are still small.