Why Medical Errors Don’t Get Fixed

Welcome back, everybody, once again to our Friday series on medical blind spots, medical gaslighting, and becoming a medical feminist. So I want to talk first about some more of these medical blind spots and just dive into frontal lobotomies. Did you know we used to actually remove parts of people's brain to treat mental health issues? I remember watching a movie in high school, One Flew Over the Cuckoo's Nest with Jack Nicholson. At the very end of the movie, he actually gets a frontal lobotomy and drives one of the guys crazy in the insane asylum. But it was such a common thing, actually, this idea that we actually had a movie about that actually sold and, you know, had Jack Nicholson in it. But we got it so wrong. And I was actually, when I was looking at this a couple months ago, the last frontal lobotomy that was done in Europe was in France in 1991 for mental health issues. So, you know, the United States was late '60s, early '70s. But the point is like we were actually cutting people's brains out to quote unquote help them. Now, lest you think this is the only time things like this happen, let's talk about smoking as another massive blind spot. It took over 50 years, 7,000 research articles before the Surgeon General of the United States said smoking causes cancer. Okay. That's crazy. And I'm actually remembering a book, history book. I'm really big in history. Several years ago, I was talking about, it was more of like an East versus West kind of interaction of different cultures and stuff. It was interesting when the British were interacting with Chinese, one of the things that happened was the Chinese became addicted to nicotine cigarettes. So the Chinese, part of them pushing Europeans, particularly the British out, was they saw their soldiers getting addicted to nicotine and how negative it was for the health and the performance as soldiers. That's like 400 years ago. The Chinese saw intuitively, hey, this is bad. It's affecting our military. We want it gone. In our country in the 1950s, doctors were saying, I smoke Lucky Strikes. I smoke Camels. Marlboros are good for your health, right? Actually, more doctors smoke, you know, cigarette X than Y. This was actually in the marketing. This was in journals and magazines. In the early '70s, the American Medical Association, my organization, you know, said it's controversial. It's controversial that smoking's bad. We need more research. Well, at that point in time, they'd gotten $20 million to do research from Philip Morris into the topic. And so the result, the result was we need more research. We're not quite sure if smoking is bad for us. It wasn't until about early '80s, I think it was '82, '83, the Surgeon General of the United States, C. Edward Koop, said definitively smoking causes cancer. Now it's on the cartons. What's the point? This was a massive blind spot. We got this so, so wrong. So wrong that it's actually had a massive impact on our country, on health, a whole bunch of things. Fast forward to vaping. I remember actually I was on X 2 years ago now, the old Twitter, X, and I, I have concerns about vaping and this is not the forum for that here. But my question is, is vaping worse than smoking? Okay. Why do I say that? Because being maybe 15 years into the vaping epidemic, you know, you might call it that. We're already starting to see young kids in their mid to late 30s getting popcorn lung. Which, if any of you know what popcorn lung is, that was a thing that usually women working in popcorn factories, they'd make the popcorn, right? And this powder, the powdered butter, they inhale it and it would cause this emphysema-like ground glass appearance in their lungs on X-ray. Kind of look like popcorn on the X-rays. But it's a type of emphysema induced by inhaling these small powder from the powdered butter and popcorn. Well, we started seeing the exact same phenomena in vapors. So the question is, are these kids after 15 years? Now, the reason I'm concerned about that is it took 30, 40 years of smoking to get, you know, COPD, emphysema. And in that case, typically only about 10 or 15% of people will get clinical COPD or emphysema. Yet we're seeing this 15 years. We're also seeing cerebral atrophy. So shrinking of the brain in these patients, typically, I shouldn't say patients, individuals. So I put a thing out there, hey, I'm worried about vaping. You would have think I, oh my gosh, I got semi-cancelled, right? Oh my gosh, you're a horrible doctor. You're a fake doctor. I looked at your website. You're a charlatan, blah, blah, blah. And it was just one of those things where I'm like, I'm just trying for us to think critically about vaping. It's not good. I remember American College of Chest Physicians reading in my, well, my journals, which is American Academy of Family Physicians, recommending vaping as a way to get off smoking. Those recommendations kind of died down a little bit, maybe 7 or 8 years ago, but they're still, still recommending as of 2 years ago to vape instead of smoking. I think we're going to find out in a little bit here that vaping is really bad, which, you know, I think at this stage most of us know that. But the point is there's things we get wrong so often, and even the most astute, most educated providers, physicians, based on their biases, will get things just plain wrong. We can look at the smoky one and go, yeah, I got that. Look at the frontal lobotomy one. Okay. I understand that. My question about the blind spots is, and always has been, if we're getting it this wrong, like right now, how wrong is it? Or the other things we're getting wrong. And that kind of leads into the other blind spot I want to talk about in this episode, which is medical error. So medical error, it's errors in medicine. That's pretty basic. When I was in medical school, I was taught that iatrogenesis, which is like doctor-induced things, typically from medications or surgeries, represented about, was the 5th most common cause of death in our country, which is still a big number, still a big number. Well, Martin McCarry published in the British Medical Journal a couple of years ago, maybe a year or two ago, looking at, it was an actuary, a Medicare actuary in, at Massachusetts General Hospital. And what they saw was that in that population, medical error counted was about the third most common cause of death in that area. Now you gotta think about this. This is looking at Medicare patients. It's not looking at women in childbirth, young kids, you know, a bunch of things, et cetera, et cetera. So in this older population, medical error clearly appears to be the third most common cause of death. What if we include everything, everything into that picture? Is medical error number two, number one cause of death? The reason this is a big deal is medical error is preventable, just like Airplane accidents are preventable, but our system chooses to overlook it, to cover it up, to ignore it because of malpractice issues, because of prestige issues, and a bunch of things. It's funny, airline pilots, they have a near miss, they have a board, they can just write on it, I had a near miss, I almost did this, blah, blah, blah. And they write it on the board, they 100% get exonerated. There's no backlash. But that allows every time there's anything that happens, even questionably wrong, for it to get a complete SWOT analysis to look at and figure out post hoc, what happened, what was going on, how can we actually fix it? Not have this happen again. I took that into my medical practice while I was in the military, that idea. And when, when something happens to the patient that doesn't turn out quite the way it's supposed to, I always look at the chart, figure out what went wrong. Was it my fault? Was it communication? Was it patient error? Was it just, you know, some more unforeseen thing? Our healthcare system does not do that at all, period. And so Medicare may be the third most common cause of death in our country. It may be number 1 or 2. We don't know. The point is, this is, these are 3 examples of blind spots. Things in our healthcare system, things that we overlook because of our prejudice, our egalitarian thinking that we're so educated, and something, things that we think to be true that are false and things we think to be false are true. So I'm going to keep on talking about these medical areas, but I also want to expand it to gaslighting, where we actually make people feel kind of crazy. And then the idea of being a medical feminist because of this. Because in many states this adversely affects women much more than men, which is, we'll talk about that a little later on. So we're gonna keep on doing this series. Hope this is helpful. If nothing else, the purpose of this is for people just to become educated, to become active in your healthcare, to not take things for granted, to question the experts. It's okay to question the experts. It's okay in a respectful way. It's okay to ask questions. But if medical error really is the third most common cause of death in our country, and Blind spots are still a thing. And we have all these things going on with medical gaslighting. It behooves you as the patient to become educated. We have lots of resources. We have these videos, we have podcasts, we've got on our website a book reading list, including Dr. McCary's book, Blind Spots, um, YouTube channel, all those sort of things. So we try to put things out there for you to actually have things to consume to help become educated. So take care. Hope this was helpful and we'll talk to you soon.