A published article in the peer-reviewed journal BMJ has piqued interest in our society recently because of its conclusion that medical error is the third leading cause of death in the US, behind heart disease and cancer.

It is possible that this is of interest to the general population because it is new and surprising finding. Prior to this study, rankings of causes of death were typically compiled and disseminated by the Centers for Disease Control and Prevention (CDC), which took information from death certificates in the country. However, a major limitation on this is that there are only certain codes that could be listed in the death certificates, and other causes, like human and system factors, were not captured.

This new study attempted to account for this discrepancy, and shine some light on what is, if this analysis is correct, a serious problem in our society.

One reason for this lack of data is a lack of transparency by health care providers. There is little incentive by hospitals to report preventable errors, and at this point not even a place on the death certificate to state whether the death was preventable. Instead, hospitals have internal Quality Improvement committees to deal with medical errors internally. Of course, these committees are shrouded in secrecy and conclusions reached within them are protected from discovery.

The result of this lack of transparency is a lack of accountability. Countless times in our society a preventable death occurs due to a human or systems error in a hospital, and the hospital suffers no consequences. Without any consequences, there are inadequate incentives to improve safety and prevent another, similar tragedy from occurring.

A possible first step towards greater transparency would be to contain an extra space on the death certificate asking whether a preventable complication caused by the patient’s medical care contributed to the death, as suggested by the study. How often these would be accurately filled out is debatable (certainly there will be pressure to under report preventable deaths) but it likely would help. Perhaps another step would be to ensure the independent nature of the physician filling out the death certificate. From there, independent groups could monitor and report on the incidences of preventable deaths at local hospitals, and perhaps this greater transparency will force hospitals to get safer.

All of this is theoretical at the moment, but this journal article is a good first step in that direction. You can read it here:

[Medical error—the third leading cause of death in the US](http://www.bmj.com/content/353/bmj.i2139)