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A Run for Safety


 

It was when my lung fell out that it hit me. No, come to think of it, it was before that, when a scorpion struck my left calf. Or it might have been when my heart exploded. No, it was earlier than that—probably around the time my right lower abdominal quadrant was gutted by that wild boar. No, actually, it was even earlier than that. Somewhere around the time I pulled my 204th muscle. Yeah, that was it. That’s when I first wondered why there is no “fun run” for safety.

Truth be told, there was no de-lunging, scorpions, cardiac explosion, or wild-boar-goring. It just felt like that. The reason: I was running. The occasion: an annual fun (?) run to support Crohn’s disease and ulcerative colitis. Why I, an out-of-shape specimen blessed with a superhero-like affinity for both chips and the couch, should be pounding the pavement early on a Saturday morning is a case study in wifely nagging.

And misplaced healthcare priorities.

You see, I have neither Crohn’s nor ulcerative colitis, have no friends or family members with them, and, frankly, rarely even provide care for patients with these diseases. What I do have is a gastroenterologist for a wife. A gastroenterologist who passionately supports gastroenterological problems; a gastroenterologist who doesn’t herself like to participate in fun runs; a gastroenterologist who relishes, apparently, seeing her husband sweat lactate while testing the anaerobic limits of the human organism. This was the nagging part.

As the gun reported at 7:30 a.m., there I was, fidgeting nervously at the starting line in a moth-eaten cotton tee from the last road race I had run—in 1989—while those around me gave my too-short, reversible, blue-and-white gym shorts the up-and-down. Cotton socks crotched, feet pre-blistered, I departed, feeling good—for the first four meters.

The next 4.99 kilometers proved slightly more daunting—providing an abundance of K’s to ponder the misplaced healthcare priorities part.

We can’t cure cancer patients if our health delivery system kills them first.

Running in The Trees

After I expertly buried the first 100-meter downhill, the race entered a well-worn, tree-lined footpath. I was shocked by both the splendor of the environs as well as the hordes of people passing me. I was comfortable with the concept of the taut young adults leaving me in their dust and, even, sort of, the superiorly fit elders. The pre-teens were more unsettling. As were the walkers—especially the walker using a walker.

It’s interesting, the relationship between road races and medical diseases. It’s not surprising, really, that generally healthy specimens would band together and use exercise as a weapon against disease—it’s actually quite noble. And common. My guess is your hometown counts numerous foot, bike, and foot-and-bike races supporting the eradication of myriad medical maladies.

In the span of just a few months, I’ve noted local races raising awareness of neurologic disorders (multiple sclerosis, Alzheimer’s, stroke, spinal muscular atrophy), cancer (breast, prostate, lung, leukemia, lymphoma, colon, skin, sarcoma, carcinoid), infectious disease (HIV/AIDS), and other medical conditions or causes (cystic fibrosis, cleft palate, pre-eclampsia, transplant, veterans).

Now, don’t get me wrong: I fully support any fund- or awareness-raising events targeting specific diseases or causes. In fact, if I were only slightly less slothlike, I’d participate in more of them. It’s just that in the grand scheme of things, it seems we are missing the forest through the trees. Finding a cure for cancer will matter little if we can’t deliver that cure in a safe, efficient, high-quality manner. Put another way, we can’t cure cancer patients if our health delivery system kills them first.

Seeing the Forest

And kill them we do. Now, you may not like the word “kill,” and certainly it makes me uncomfortable, but what other word better characterizes the situation? Medical errors result in up to 200,000 preventable deaths per year, according to the recent HealthGrades patient safety report.1 This study reviewed Medicare data from all 50 states and found a mortality rate that was nearly double that reported in the seminal 1999 Institute of Medicine report (44,000-98,000; extrapolated from data in three states).2

And these are just deaths in hospitals; no mention is made of community or residential deaths from medical error. These data also don’t account for the pain and suffering left in the wake of the estimated 15 million annual episodes of harm (that’s 40,000 per day!).

In the end, the World Health Organization (WHO) estimates that 10% of hospital stays involve a serious, preventable, adverse event. Which of the 10 patients you’ll see tomorrow will suffer that serious, PREVENTABLE harm?

Using a conservative average of the two reports, roughly 100,000 people die annually from hospital-based medical errors. This slots medical error as the sixth-most-common cause of death in the U.S., trailing only heart disease (616,067), cancer (562,875), stroke (135,952), chronic lower respiratory disease (127,924), and accidents (123,706). If we use the 200,000 estimate, then error trails only the heart and cancer as a cause of death. And, in terms of individual cancers, only the lung (156,940) kills as many Americans as medical errors. Colorectal (49,380), breast (39,970), and prostate (33,660) don’t even come close.

Yet these data appear to be lost on the legions of race organizers. A Web search uncovered not a single organized race event trying to counter the perils of medical error. No Lance Armstrong, no Katie Couric, no Jerry Lewis. Nothing.

Thankfully, these data are not lost on the ones who bear the brunt of these errors. A Commonwealth survey reported that 22% of respondents were aware of a medical error in care provided to them or their family. Another paper following the release of the IOM report put the number at 42%.3,4

Still, nary a race “K” has been devoted to reducing medical errors.

Harriers Against Harm

As the finish line draws near, I note that the overhead scoreboard has taken on the appearance of the national debt clock in Manhattan—a large number rapidly getting larger. The replenishment table is littered with crumpled Dixie cups, the music has drifted, and the crowd has dwindled to a handful of volunteers, many of whom tap their toes awaiting my finish.

I wonder what it’ll take. If 12,000 people with spinal muscular atrophy is enough to convene a race, what of the millions of people harmed annually by medical errors? How many more have to die before patient safety becomes an issue, becomes it’s own cause, gets it own fun run?

Dr. Glasheen is associate professor of medicine at the University of Colorado at Denver,where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.

References

  1. HealthGrades Eighth Annual Report on Patient Safety in American Hospitals Study. Available at: www.healthgrades.com. Published March 2011. Accessed Aug. 31, 2011.
  2. Kohn LT, Corrigan JM, Donaldson MS, et al. To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academies Press, 2000.
  3. The Commonwealth Fund 2002 Annual Report. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Content/Annual-Reports/2002-Annual-Report.aspx. Accessed Sept. 9, 2011.
  4. Blendon RJ, DesRoches CM, Brodie M, et al. Views of practicing physicians and the public on medical errors. N Engl J Med. 2002;347:1933-1940.

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