20: The Silent Kill in the U.S, it's not just in hospitals with Dr. Aaron Hartman

What is medical error? Medical error is misdiagnosis. Medical error is medication complications, side effects from surgeries. You get hip replacement surgery, you get a kidney infection, you get a lung infection, you get hospitalized, you get hip fracture, and you die related to that. But the point is things doctors do. I tell patients I am the third most common cause of death in their country. What is the third most common cause of death in our country? Think about it. What do you think it is? It's not what you think. The first one, which I think most of us know what it is, It's. It's heart disease. If you're a female who's diagnosed with breast cancer, your most common cause of death in our country still is heart disease. So that just tells you how far we've come with managing cancer. The number two cause of death in our country is cancer. So it's all the cancers combined. So the question becomes, what is number three and why should you care? It's not what you think. It's a big deal. And according to an article in the British Medical Journal, this is from 2016, the lead author on this editorial analysis, Medical Error, the third leading cause of death in the United States, is the title published in 2016. So this information is not even. It's not even new information. It's medical error. Now, the article is really interesting and actually it's pulling some data from some. Some studies from Harvard. It's looking at a lot of Medicare actuaries, looking at hospitalizations and things like that. But medical error, what is medical error? Medical error is misdiagnosis. Medical error is medication complications, side effects from surgeries. You get hip replacement surgery, you get a kidney infection, you get a lung infection, you get hospitalized and you get hip fracture and you die related to that. But the point is, is things doctors do. I tell patients I am the third most common cause of death in our country. The mantra, first and foremost, do no harm is a very real thing. The Hippocratic growth. Our goal is to first and foremost, do no harm. I remember when I first joined my practice here in Richmond back in 2007. One the main. The actual physician who started the practice would always tell me that our job as the hospital, I was working in the hospital. That point in time was to prevent the hospital and the system from killing our patients. And I thought he was a little over the top. I remember reading later on about 2010, that complications, surgical complications, a lot of things that we do was the fifth most common. Iatrogenesis was in the article was referring to atrogenesis which is the results of things that doctors do, was the fifth, but now it's number three. Why is this important? Because in a debate right now in healthcare, big debate right now, right? Not to get political. This is not a left versus right thing. This is a patient care. This is just living is. Our healthcare system is not benign. Medication complications, interactions of medications, surgical complications, misdiagnoses. And the thing about it is, our healthcare system is not set up to deal with this. If you're an airline pilot, if there's not every time there's an accident, right, A collision. We had a couple this year, actually, usually within a month or two, you get a complete report. Everybody in the country knows what happened. There's an issue with ground report. I remember this one. It was actually an accident with some Korean pilots and they actually weren't paying attention to the readout and actually ran right into a mountain. In the airline industry, if there's an accident, they take months, years sometimes investigate found the calls, change the protocols and adjust it. We do not do that in medicine because of, because of our medical legal environment, because of the risk of being sued if there's an accident, we first kind of look around, see if anybody saw it, and kind of forget about it. And we don't actually learn from our mistakes. And if there's a mistake, whether it's medication side effect or a vaccine side effect or a surgical side effect, we tend to minimize it and say, oh, it's not a big deal. But then people talk about it, we demonize them. We say, well, are you conspiracy theorists worrying about, you know, complications from medications or side effects from statins, which is a cholesterol medication, or proton pump inhibitors or antibiotics. Antibiotics are safe. We should put antibiotics in the water. Remember that? That's what I was told when I did my training. I was told in college when I used to get amoxicillin for every strep throat I got that there were no side effects from antibiotics. Well, now we have antibiotic resistance, we have C. Diff colitis, we have a whole lot of things we've learned about the human microbiome. And actually now we know that antibiotics in childhood increase your risk for adult autoimmune diseases, asthma, even certain cancers. And this, this data is not included in the medical error. So maybe numbers may's number two, not number three. The point is, is we have to take first and foremost, do no harm seriously. We have to. If people, if your physician, your, your provider needs to take you seriously when you have concerns, when you're like, hey, this medication, should I be worried about it? The surgical procedure that you say is safe, the screening procedure. It's interesting. Mammograms were an issue a couple years ago where the US pftf, which is the, it's, it's the United States main organization that makes screening recommendations, made a recommendation to, according to the Cochrane Database, which is the big evidence based database thing out of the UK, to change mammogram screening in the United States to 50 and every other year.

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And the outrage was huge. Oh my gosh, you're killing women. This is horrible. But you look at the data, if you get a mammogram every year for 20 years, you increase your risk for breast cancer 25%. Okay. And there's a 10% false positive rate with mammograms, which means if you do 100 mammograms, 10 women will be falsely positive. They get an ultrasound, they get a biopsy, they get a lumpectomy. It's questionable cancer. They might get treated for a questionable thing. And it's really interesting because we know that women in their 40s. There's one interesting study looking at women who actually had in their 40s who died in car accidents and had autopsies done. And a little less than half of them had breast cancer. Not the cause of death, but in their breast when they died in the car accident. And those breast cancers were involute, they go away after menopause. So that's one of the reasons why non invasive ductal cancer sometimes we can actually watch it we don't have to do radical treatment. So all of a sudden, now the concept of something as simple as a mammogram, something as simple as a medication, there are complications, there are risks. And you need to really think these things through and not just be like, oh, don't worry about it and use the patient, or as a practitioner, need to take your patients seriously when they have concerns about medication side effects interactions. Because medical error is the third most common cause of death in our country. Now the one interesting thing about this analysis that Marty Makary, which I think now is the head of the FDA or something like that in our country right now, he wrote some couple, couple great books. One's one is Blind Spots, which talks about some of these issues. Another one is the Price We Pay, which talks about the cost of health care, our healthcare system. So two great books if you want to learn about how our system works. In this particular article they talk about some of the nuances of the data where looking at hospitalizations with Medicare patients, one suggested that maybe 400,000 deaths a year occurs by error in the hospital. Another said maybe it's 150,000. So this the question with it being the third most common, is it the fifth or is it the second? I think the gist is we need to really research this and we need to be open to it. We need to start having some common panels when they're. When people die in the hospital, when physicians need to be free to discuss things. I remember when I had one of my early on my career, I had a patient who had a heart attack in his 80s. I'd see him in the clinic, doing great in health, nice guy. He was playing golf. He was playing golf all the time in his 80s and having some chest pain. And so I'm like, oh, just you're 80. We'll get check, we'll get a stress test on you. No worries. Got set up. They called to set it up. He didn't answer the phone and had two weeks later had a massive heart attack and died. And when I got information back about them, like here what I went back and looked at the chart. What did I miss? I went through it and like his reviewed his symptoms. They were not typical angen. It was just weird chest pain that didn't sound cardiac. The only reason I even ordered the stress test because he was old and he played golf like three times a week with no problems whatsoever. His symptoms had nothing related to his exertion. I looked back to evaluate, did I miss something? The answer was no, it was just one of those things. If he picked the phone up, if I'd been more aggressive and demanded him getting the stress test, maybe the outcome could have changed. That kind of curiosity is not in our healthcare system. It's dissuaded and we really need to change the culture. Patients need to demand different, but we also need to just interact today's world. We need to be more demand more for healthcare providers. We need to be more interactive. And if you're seeing a specialist or a doctor who blow you off with your concerns, maybe get this JAMA article and say, well, medical error is the third leading cause of death. This is published in the British Medical. I'm sorry, British Medical Journal. Why should I not be concerned about the drug you just prescribed and well meaning genuine physicians will have a conversation with you now they're limited in time, they only have the average, I think the numbers now the average primary care visit, six minutes. So you might have to schedule a follow up visit. The nice thing I love about AI, we're using a lot of AI in my practice now just for like different things. As you can take this article, you could download it into Claude or Perplexity, wherever your AI tool is and then ask the article questions and say, and also say, referencing Marty McCary's book Blind Spots and just, just give me some more information. You can actually interact with this information so you can actually kind of sort of direct your own education. Which is one of the reasons I love AI, for those who kind of know how to use it. But anyway, hope this information is helpful if it is like share, subscribe, ask your questions, we'll try to answer them as best we can. I'm going to be doing these little mini, kind of mini podcasts, so to speak, mini things where I take a topic that people have asked me about or that's trending or that seems interesting me and can take a little deep dive. This has met me about 10 minutes. If you enjoy this, please let me know, give me your comments, how I can make it better and share it. That's how we get this information out. So otherwise, hope this was helpful. Take care and we'll talk to you soon.