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Recalling To Err’s Impact — And A Small But Telling IOM Mistake


November 25th, 2014

This year marks the 15th anniversary of the Institute of Medicine (IOM)’s To Err is Human report, which famously declared that from 44,000 to 98,000 Americans died each year from preventable mistakes in hospitals and another one million were injured. That blunt conclusion from a prestigious medical organization shocked the public and marked the arrival of patient safety as a durable and important public policy issue.

Alas, when it comes to providing the exact date of this medical mistakes milestone, the IOM itself is confused and, in a painful piece of irony, sometimes just plain wrong. That’s unfortunate, because the date of the report’s release is an important part of the story of its continued influence.

There’s no question among those of us who’d long been involved in patient safety that the report’s immediate and powerful impact took health policy insiders by surprise. The data the IOM relied upon, after all, came from studies that appeared years before and then vanished into the background noise of the Hundred Year War over universal health insurance. This time, however, old evidence was carefully rebottled in bright, compelling new soundbites.

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Not In My Name: Real Patient-Centeredness Means Sharing Power


February 26th, 2013

It is as natural for doctors, hospitals, health plans and others to aggressively affirm their “patient-centeredness” as it is for politicians to loudly proclaim their fealty to the hard-working American middle class. Like the politicians, the health care professionals no doubt believe every word they say.

The most accurate measure of “patient-centered” care, however, lies not in intentions but implementation. Ask one simple question ­– what effect does this policy have on patients’ ability to control their own lives? ­­­– and you start to separate the revolutionary from the repackaged. “A reform is a correction of abuses,” the 19th-century British Parliament member Edward Bulwer-Lytton noted. “A revolution is a transfer of power.”

With that in mind, which purportedly patient-centric policy proposals portend a true power shift, and which are flying a false flag?

Falling Short Of Shifting Power

The two most prominent examples of initiatives whose names suggest power sharing but whose reality is quite different are so-called “consumer-driven health plans” (CDHP) and the “patient-centered medical home” (PCMH). Both may be worthy policies on their merits, but their names are public relations spin designed to put a more attractive public face on “defined contribution health insurance” and “increased primary-care reimbursement.

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The Toll Of Preventable Errors: How Many Dead Patients?


March 9th, 2012

Here’s a quiz for Patient Safety Awareness Week (and after): The number of Americans who die annually from preventable medical errors is: . A) 44,000-98,000, according to the Institute of Medicine B) None, thanks to the Institute for Healthcare Improvement’s “100,000 Lives Campaign” C) 90,000 D) No one’s really counting The correct answer is, “D,” […]

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Why We Still Kill Patients: Invisibility, Inertia, And Income


December 6th, 2010

A recent front-page article in the New York Times conveyed grim news about patient safety. The first large-scale study of hospital safety in a decade concluded that care has not gotten significantly safer since the Institute of Medicine’s 1999 estimate of up to 98,000 preventable deaths and 1 million preventable injuries annually. What for me […]

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Remembering Jay Katz: The Enduring Voice Of “The Silent World”


December 28th, 2008

By the fourth sentence of the preface to The Silent World of Doctor and Patient, Jay Katz has quietly issued a startling challenge to a fundamental principle of the doctor-patient relationship. He writes: It took time before I appreciated fully the oddity of physicians’ insistence that patients follow doctors’ orders. During my socialization as a […]

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Eight Days: A Health Care Diary


July 10th, 2008

PAIN (Chicago, June 19 – June 21) I sit down at a circular table in the high-ceilinged meeting room and conversationally ask the two women already there what brought them to this three-day conference. The first replies that she had a daughter die from a medical mistake. The other, a nurse, lost a son to […]

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HUCKABEE-STYLE HEALTH REFORM: Morally And Physically Fit


January 31st, 2008

Back in November, Republican presidential candidate Mike Huckabee wrote a remarkably candid essay for a special election issue of the trade journal Modern Healthcare. Since then, the former Arkansas governor’s campaign has morphed from single-digit obscurity to mainstream prominence, and the candor on health care has mostly been scrubbed clean from his Web site. Nonetheless, […]

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