If doctors aren’t sufficiently washing their hands today it’s arrogance/laziness/assholery rather than not knowing. Fixing the problem is about culture change, which is always hard as hell.
And if I recall the story that guy specifically thought doctors should wash their hands between autopsies and child births. The thought of which sort of sends a chill up my spine.
It’s like a morbid Reese’s Peanut Butter Cup
“You got your death on my baby!”
“You got your baby on my death!”
“Oh, now its just all death.” 
And went right on operating with dirty hands.
There was a forty year gap between Lister’s discoveries and the widespread adoption of antiseptic practice. Basically, it didn’t happen until all the pre-antiseptic doctors were dead.
Which seems like it should have happened faster than it did…
Paracetamol:
“Therapeutic blood (its serum or plasma) concentrations range from 5 to 20 mg/l. Toxic blood concentrations are in the range of 25-150 mg/l [2, 3]. The minimum lethal blood concentration is 160 mg/l [3]. Mean lethal blood concentration is 300 mg/l [2].”
Aspirin:
The therapeutic range of salicylates is 15-30 mg/dl. Patients are symptomatic at concentrations over 40-50 mg/dl. Levels over 90-100 usually have serious or life- threatening toxicity.
I admit I was thinking about the index for animals, which is based on LD50, but the fact remains that the maximum therapeutic doses of both are below a third of the lethal dose. Toxicity can be treated, whereas gegen den Tod ist kein Kräutlein gewachsen
As I understand it the problem with opiates is the development of tolerance, which makes things difficult because the therapeutic and the lethal concentrations overlap in the population. One heroin dealer supplying heroin more pure than usual can kill a number of people. Of course there are many other factors involved, social and political, but as with all drugs these must be taken into account in medical policy.
Your statement about the behaviour of cannabis as a painkiller falls, I think, into the “unproven” category. AIUI proper clinical research into the subject only really got started in 2016, with previous research being too anecdotal or poorly controlled to be authoritative - and given the climate of opinion and legislation, that isn’t surprising. We don’t know, but we have a lot of anecdotal opinion (possibly starting with the French physician Francois Rabelais in the mid 1500s) that, if the subject wasn’t so bound up with the monopolies of supply of other drugs, would have probably had a lot more attention.
Let me rephrase: we need to remove the malpractice industry from the equation when it comes to preventable deaths. That doesnt mean killing all the lawyers. Nor does it mean that doctors cannot be sued for misdeeds. But, malpractice lawsuits need to be about taking away medical licences from doctors who do not deserve to have them, and not about financial penalties.
Take away the financial incentive, so that human error does not result in a lawsuit, and so that doctors and hospitals do not need to fear admitting to error. Then you can start to address the errors and find ways to eliminate them.
the funny thing is, the midwives were doing just fine because they weren’t fingering dead bodies in between births, and no one could figure out why, and the physicians (all men at the time) thought it was so ridiculous that women could be better at something that they just dismissed all evidence completely.
These figures and the focus on medical errors originate from the Institute of Medicine 1999 report To Err is Human. The methodology is complicated and unreliable and the availability of data a huge issue.
Thus international comparisons is difficult. Mostly, a useful wake-up call for the medical profession to re-evaluate the impact of their decision making. Unfortunately, these findings have (in places) been turned into something to beat up clinicians with. e.g. by the UK Health Secretary whose tenure is marked by antagonism towards health professionals.
Open discussions of the limits, potentials and expectations invested in medicine are key. Placative headline data–which forgets to correlate the data of medical error with the number of people whose lives are saved by medical intervention is not always helpful–me thinks.
Lister at least remained a practicing and respected physician. Semmelweis on the other hand landed in psychiatry for suggesting that washing hands between dissecting corpses and delivering babies might save lives.
One of the main motivators for malpractice suits is to ensure adequate care for patients injured by medical error. If on the other hand you had a health care system which would ensure that anyone ill or disabled would receive the optimal care and that their families are well supported–you wouldn’t need malpractice suits. But currently there is no such medical system, not even in the UK under the NHS, so legal processes are the only way patients have to live in even remotely acceptable circumstances after a medical error.
This, this, this, this, this, this, this. Thank you!
In the USA, Medicare is now planning to reduce reimbursement for bad (read “high cost”) outcomes for surgeries such as hip replacements. Well, patients with complicating conditions going into surgery are more likely to have those high cost outcomes.
The incentives are now in place to steer those patients to Tylenol rather than a new hip. The chance of medical errors reduced, but ask those patients who were told “No hip for you!!” if that’s an unalloyed good.
And of course we in the USA have our wonderful FDA, whose functionaries suffer career death if they allow a drug onto the market which has a side effect which might kill one person, but keep their jobs for life by delaying drugs that could save a hundred thousand.
Actually, the NIH estimated that deaths from medical error accounted for 141,700 deaths worldwide in 2013.
A study from John Hopkins University contends that misreported statistics means the US alone actually has 250,000 medical error deaths per year, which suggests perhaps a uniquely American medical system problem may actually be underfoot.
Yes.
You are comparing apples and oranges.
The statistics you quote is about changes in the causes of death world wide over a 13 year period.
Unsurprisingly, in places like the DRC or Haiti a vanishingly small numbers of deaths are caused by medical errors as there is no medical provision to speak of.
The NIH has invested considerable resources into studying adverse events in medicine in the US system, other health systems have not. They look to the US for reference.
This is a classic case where being transparent makes you look worse.
The US has a huge problem with public health outcomes, but there is no indication that US clinicians harm their patients more than those in e.g. UK or Germany. There are way to many uncertainties in the data to make such statements.
I haven’t been able to access the Washington Post article yet (keeps crashing on me) but from the brief summary, I think they are measuring two different things.
I think the NIH is measuring cases where an otherwise correct medical intervention is made which has an adverse effect and someone dies, i.e. someone is prescribed antibiotics, turns out to be allergic and dies.
‘Medical Error’ in my view covers a much larger area including such things as Dr. didn’t read patient’s notes which clearly said patient allergic to penicillin, gives patient penicillin, patient dies or Dr. misdiagnoses, patient gets wrong treatment, dies.
I would hope the first is much smaller than the other.
Far more complex. Availability of adequate sinks, appropriate level of staffing all play a significant role. Hand washing as most other things are about priority setting, and the system needs to ensure that the facilities and resources are available for setting the right priorities. Too often in health care that is not the case.
Your points #1 and #2 amount to “stop interfering with physicians ability to treat their patients”. It is true that physicians are human and therefore some will make mistakes or do things from evil motives, but so will any other class of humans. Physicians, whatever their frailties, are at least a subclass of healers.
But then your point #3 completely stands your previous message on its head, and says legislators - a category of humans even less trustworthy than priests ffs when we’re talking about making informed medical decisions - should be able to override physicians, and prevent healers from using their best judgement when prescribing.
And thus the push to replace opiates with opioids in the minds and medicine cabinets of voters. They might not be honest enough to admit it, even to themselves, but politicians and media pundits profit when people suffer and die avoidably. Therefore, doctors can’t be allowed to prescribe safe, effective, and highly addictive codeine, instead they must be incentivized or propagandized into prescribing unsafe and equally addictive drugs like vicodin, oxycontin, and fentanyl.
BTW, @Wanderfound, I think the paper you linked re: pneumonia vaccination was beautifully written. I read scientific papers fairly regularly, and most of them are almost painfully badly composed, particularly in the life sciences.
Very right. Doctors and nurses can be chronically sleep deprived and rushing from one thing to the next.
It’s still a cultural problem, but the resources have a huge impact on that culture. Like I’m frustrated that no one sits down in my movie theatre when I didn’t bother having seats installed.
Thank you for being a voice of reason in this.
Re:German stats and jurisdictional differences, I assume this is a good example. “Kunstfehler”, or medical malpractice, is to the best of my knowledge quite a distinct thing under German law. Medical error seems to be a much broader field, especially when I read above that hospital infections (like pneumonia) might fall in that category. I would never think they would - there is no “error” directly committed per se if your weakened immune system can’t cope with a usual hospital infection. MRSA and the likes are another story, but still, in Germany, there needs to be a well-founded assumption of schuldhaftem Verhalten to count such cases as medical error, I think.
