Cures That Kill

A caution on drugs and surgery

Patients have long been aware that doctors sometimes kill as well as cure. Doctors have long insisted that medically caused mishaps do not occur in significant numbers. Now two medical research teams in Boston have challenged that assumption. One team, led by Geriatrics Specialist Knight Steel, found that out of 815 patients admitted during five months of 1979 to a hospital at the Boston University Medical Center, 290 suffered almost 500 medical mishaps. More than 200 of these complications were due to drugs. An additional 175 resulted from other treatments or diagnostic tests. These mishaps contributed to the death of 15 patients. At the Brigham and Women's Hospital, Surgeon Nathan Couch and colleagues reviewed the cases of 5,612 patients admitted for surgery in 1978 and 1979. According to Couch, medical mishaps (costing at least $1.3 million in extra care) occurred in 36 patients, leading to serious physical impairment in five people and the death of eleven. Says Couch: "Obviously, we are not dealing with an irreducible number of complications."

Couch attributes surgery-related mishaps to clearly avoidable errors by doctors who were too quick to operate, too confident of their skills and techniques, and too concerned with doing currently fashionable procedures. By contrast, Steel feels it is often impossible to assign blame for complications that occur among general medical patients, and that this is even more true for the many elderly patients with multiple ailments in the study. The complex of diagnostic tests and drugs used makes it difficult to isolate any one cause of trouble. Says Steel: "I don't really know for certain if any of these cases are preventable. It is all too difficult to judge."

Though increasing fear of malpractice suits and touchy medical egos make candor difficult, both Steel and Couch urge more open, self-critical discussions of medical mishaps by physicians and hospital staffs. Says Couch: "If you hear about some mistake, you certainly are less apt to repeat it. It's a cheap way to gain experience." The teams also recommend that doctors keep patients and families fully informed throughout the hospital stay. "Doctors often underestimate a patient's intelligence," notes Couch, "as well as the family's willingness to be cooperative."

Judging by their colleagues' initial reactions to the reports, the research teams think it may be a long time before physicians squarely face up to responsibility for medical mishaps. Adds Steel: "The profession tends not to monitor such problems."

This file is automatically generated by a robot program, so viewer discretion is required.