Doctors: See No Evil
Hey, you know what happens to you if you screw up on the job -- you get reprimanded...or fired. But have you ever wondered what happens to your doctor if he/she messes up? Well, according to a study published last month in the Annals of Internal Medicine, although 96% of doctors surveyed "agreed that physicians should report impaired or incompetent colleagues to relevant authorities, 45% of respondents who encountered such colleagues had not reported them." Specifically, the report found only 55% of physicians with direct personal knowledge of impaired or incompetent colleagues in the past three years said they always reported them. And while 93% of respondents said doctors should always alert authorities when they observe serious medical errors, only 54% of those who had such information in the past three years said they always did so.
Front page news? You would think! But, in fact, other than in USA Today, it barely got any play in the media.
Interestingly enough, of all the specialties surveyed, cardiologists were the least likely to say they always reported direct knowledge of a serious medical error. They were also the second least likely (right behind family practitioners) to report an impaired or incompetent colleague. It is also worth noting that the 45% figure cited in the survey is not necessarily an accurate representation of the total number of doctors who do not inform on their colleagues. It only represents the number that admitted to not informing on their colleagues - most likely, a very different number.
Look, my goal is not to beat up on doctors here. In this regard, they are no different than a number of other professions. Police officers even have a name for this kind of studied indifference. They call it "The Blue Code of Silence," an unwritten code of honor among police officers in which reporting another officer's errors, misconduct, or crimes is regarded as a betrayal. Or to put it another way, as senior study author David Blumenthal said of the physicians in the study, "I think human beings always fall short of their aspirations." That said, I think this study reinforces a point I made a decade ago in Lessons from the Miracle Doctors, that physicians are responsible for many more deaths than are normally attributed to them.
If it's not reported, you can't record it.
Death by doctor
As I first said in Miracle Doctors, some 10 years ago:
- The April 15, 1998 Journal of the American Medical Association reported that there are more than 2,000,000 drug "reactions" annually in the United States, and that more than 100,000 of those reactions are fatal. This makes prescription drugs the 4th leading cause of death in America. But the reality is actually much, much worse. These numbers do not include:
- Patients who are given the wrong drugs, or who are given those drugs at the wrong dosage or in the wrong combination.
- Patients who have fatal reactions to the drugs, but whose death is mistakenly (or deliberately) attributed to other causes.
- A patient who is prescribed a pain killer and dies from a heart attack. How is that recorded on the death certificate -- reaction to the drug, or heart attack? Both are true, but only one is the truth.
Total up all the above numbers and add them to the aforementioned "official" count and you find that deaths from adverse reactions to drugs may number as high as 700,000 a year. (Actually, former FDA Commissioner David Kessler estimated in a speech given in 1993 that fewer than 1 percent of all doctors report injuries and deaths following the administration of prescription drugs -- which, if true, would make 700,000 an incredibly conservative estimate.) Now, combine those 700,000 deaths with the number of people who die from misdiagnosis, inappropriate treatment, secondary infections received in hospitals, or just plain physician error, and the startling fact you're left with is that modern medicine, despite all the great things it may have accomplished, is arguably the single leading cause of death in the United States.
It is not a coincidence that time after time, when doctors go on strike, mortality rates drop dramatically in those cities or countries. In 1976, in Bogota, Columbia medical doctors went on strike for 52 days, with only emergency care available. The death rate dropped by 35%. Also, in 1976, in Los Angeles County, a similar doctors' strike resulted in an 18% drop in mortality. As soon as the strike was over, the death rate went back to normal. A 50% decrease in mortality occurred in Israel in 1973 when there was a one month doctor's strike -- with similar results seen in doctor strikes in 1983 and 2000! This should not be surprising when you also note the Institute of Medicine's report, To Err is Human, states that medical errors cause as many as 98,000 deaths each year in the United States alone -- more than traffic accidents, breast cancer or AIDS. Right behind prescription drugs, medical error is the fifth leading cause of death.
The good news for doctors is that if Dr. Kessler's estimate in 1993 was correct, then 45% of doctors now lying to protect their buddies actually represents a 4400% improvement in just the last 15 years. Isn't that exciting?
Understand, this is not an attack on medical doctors -- the vast majority of whom are extremely competent, highly dedicated, and often even heroic. What I am trying to point out here is that the image of doctors presented on TV shows and through medical association press releases as all powerful, overwhelmingly dedicated, healing Gods performing miracles on a daily basis and defeating diseases such as cancer and diabetes is simply not true. Doctors are human. They do good things, and they do bad. They save some people and kill others. They gain ground in some diseases, but increase mortality in others. They also extract vast sums of money in endless research that often makes only marginal progress in many diseases -- with the promise that the next great breakthrough is just around the corner -- with the help of a few billion dollars in donations. But what makes it intolerable is that they ruthlessly stifle all competition, while at the same time, as we now know, lie to protect their colleagues and the illusion of their omnipotence -- and if Dr. Lewin is correct, their pocketbooks. (Dr. Jack Lewin, the CEO of the American College of Cardiology, commenting on the study said that many doctors fear being sued if they report incompetent colleagues. "We probably need some kind of whistle-blower protection for doctors.")
Since I first presented the hypothesis back in 1997, that going to your doctor might be the single leading cause of death in the civilized world, it has been explored in much more detail by Gary Null et al in " Death by Medicine." The conclusion reached in this study is that physicians and hospitals are responsible for just under 1 million deaths a year in the United States alone, firmly ensconcing a visit to your doctor as the single leading cause of death you are likely to face. Does that mean that my hypothesis is now fact?
No, of course not.
Obviously, the situation is not so one-dimensional. Many things doctors do are invaluable. If you're in an automobile accident or your name is John Wayne Bobbit, you're much better off with a surgeon than an herbalist. That said, when it comes to many of the major diseases of our time, you're probably far better off with an alternative healer and quite possibly, far safer.
That said, I think we can safely say that physicians are not "Gods of Healing." As we now know, they are exceedingly human.