How Many Deaths Are Due to Medical Errors?

To the Editor: Dr McDonald and colleagues¹ and Dr Leape² discussed the recent Institute of Medicine (IOM) report about medical errors.³ I am concerned, however, that deaths due to errors may mean different things to different people.

Specifically, I question some of the scenarios that Leape notes as examples of errors leading to death. He cites 3 examples: a stroke in a patient with atrial flutter, a patient with a ruptured bowel who was not taken to surgery, and a patient with hypoxemic brain damage due to hemorrhagic shock from splenic rupture. These are not what I think of when I think of errors in the hospital. All of these examples strike me as evidence that medicine is still an art. These are examples of medical judgments that were, in retrospect, wrong. Physicians make dozens or hundreds of such judgments every day, and some of these are sometimes incorrect. Without knowing the details of the cases, I can only speculate about why the patient with atrial flutter did not receive anticoagulants, why the patient with intestinal obstruction was observed rather than immediately taken to the operating room, and why the splenic rupture was not recognized. It is not difficult for me to suggest reasons why these things happened. They may indeed represent cases of gross negligence, but they also may represent cases of quite appropriate judgment made on the basis of what was then known about the individual patients. I hope that these are not the errors that we think we can correct by simply improving the "processes" of care.