Medical harm

Medical harm refers to either physical or psychological or financial harm caused to patients by health care. It could be caused by a failure in the health care system or it could be caused by the health care professionals without any system failure or even in the absence of a system. Sometimes patients are harmed as a result of a system succeeding in protecting itself.
Medicine may be a long way from creating the cognitive tools necessary for solving this problem when authorities as respectable as The Institute for Healthcare Improvement (IHI) define medical harm as the “nintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment), that requires additional monitoring, treatment or hospitalization, or that results in death."
Of concern is qualifying it as harm only if it requires additional monitoring, treatment or hospitalization. Sometimes debilitating injuries are not treatable and so do not require additional monitoring, treatment or hospitalization. Other times there is the problem of how difficult it can be for injured patients to get iatrogenic injuries diagnosed in the first place, let alone treated. Is it harm only if a health care professional can be found who is willing to point a finger at a colleague by making a record that says that the injury was caused by previous care and requires additional monitoring, treatment or hospitalization?
More important is beginning the definition with the word "unintended." Perhaps the darkest moment in all of medicine is health care professionals preying on patients. By the IHI definition intentional injuries are not harm. Acts of anger, lust, or frustration are not harm? Unnecessary surgeries for profit, are not harm? Policies that will increase the bottom line for a facility, or just be more convenient for caregivers, even though they will increase injuries, bankruptcies and mortality can be difficult to define as unintended as well. A cleaner and more inclusive definition of harm is in needed.
Even with this definition, IHI estimates that “15 million instances of medical harm occur each year”
While it is thought that some progress has been made in recent decades in determining the best ways to reduce incidents of medical harm, the number of patients unnecessarily bankrupted, disabled or killed each year has not declined. Some advocates, including Dr. Barbara Starfield
History
The term "medical harm" was first used after a Harvard Medical study in 1991 concluded that patients incurred a substantial amount of injury from medical management, and the injuries were a result of substandard care. A 1999 report by the Institute of Medicine, “To Err is Human,” further defined the scope of the problem and outlined comprehensive recommendations for reducing harm.
One of the most infamous examples of deliberate medical harm is the Tuskegee syphilis experiment, a study initiated by the Public Health Service in 1932 to examine the effects of untreated syphilis that used a group of poor rural black men as participants. The study continued until 1972, long after treatment for syphilis became widely available, and as a result several participants died of syphilis and its complications, infected their wives, and fathered offspring born with congenital syphilis. As a result of public outcry, the study was ended and new regulations for the ethical conduct of medical research were established. However, these regulations are exclusive to research and do not apply to or protect patients undergoing routine medical treatment.
Prevalence
In the United States
*10% of acute hospital admissions resulted in the incidence of an adverse event.
*In 1999, it was estimated that 44,000 - 98,000 people die in hospitals each year as a result of medical errors, making it the tenth leading cause of death.
* In 2013 - an estimated 400,000 unnecessary deaths annually in hospitals with a potentially greater number resulting from care outside of hospitals where they are not counted.
*Twenty to 30 percent of patients in the United States receive care that is contraindicated.
*Adults 65 years and older are three times more like than younger adults and 60% more likely than middle-aged adults to experience post-operative respiratory failure following elective surgery even after adjusting for co-morbidities.
*Few studies have been done to determine medical harm in the clinical or outpatient setting.
In Canada
*7.5 % of hospital admissions resulted in the incidence of an adverse event.
*In 2003, 197 deaths resulted from adverse care events, 22 from adverse drug events.
*In 2003, 5.2 million or 24% of Canadians reported they or a family member had experienced a preventable adverse event due to medical care, 52% of these reports stated the event had a serious consequence.
Although Institutions that have created "blameless" reporting systems or the ability to report "close calls" as well as actual incidents of harm believe that they have had some success in increasing reporting, these systems have not been universally adopted and the rate of the accurate reporting of problems in medicine still only is 2% with 93% of problems never being reported at all according the Health and Human Services report "Adverse Events in Hospitals.". Currently, there is no mandatory national reporting system and no reason to believe that implementing one will result in a substantial increase in reporting. Payment incentives, or penalties for hospitals that do not conform to safety standards, have also been suggested as possible mechanisms for reducing medical harm. However, some believe that the issue of reducing medical harm has not been adequately addressed and that a national regulatory body is necessary to mandate and coordinate preventive measures. Others believe that a national regulatory body cannot do what local regulatory bodies have never managed to do and only is more of what has not worked yet.

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