Doctors were once revered, respected like no other profession. When a doctor told his patient some treatment option was best, his recommendation was taken as gospel, believed without question, and followed explicitly. Times have changed. Many present to the doctor having already researched their own condition. They have arrived at a diagnosis and an appropriate treatment plan. If the doctor does not agree, a second opinion may be pursued. But being a physician is still a highly respected occupation (although nursing has moved into the number one position, according to many recent surveys).

In general, our health care is perceived as being “moderately safe” and viewed as much safer than nuclear power or food handling, but somewhat less safe than airline travel or the work environment. But the risk of dying as a result of a medical error far surpasses that of being in a fatal airline accident. Statistically, an average passenger would have to fly, around the clock, for more than 438 years before being involved in a fatal crash.

As a nation, we tend to have little knowledge or understanding of health care safety. In one survey, when asked about safety issues, fully 28% could not think of any potential dangers. As for the causes of mistakes in medicine, the participants in this survey cited carelessness of health care professionals who are stressed or overworked. How did they come to this information? Anecdotes were most often their source of information, which generally is not considered reliable. Many Americans have heard about mistakes in medicine, but usually from a relative or friend. 12% mention a personal experience. Most see mistakes as an issue with an individual provider rather than a failure of the process of health care delivery.

Specifically, a medical error can be a number of different events, including being given the wrong medication or dose, or experiencing delays or errors in laboratory test results. The numbers concerning the frequency of medical errors many find shocking. Almost 9 percent of US surgeons claim they have made a major medical mistake within the last 3 months, according to a study done by Mayo Clinic. The next question is often what is “major”? The worst outcome certainly is death, with the physicians polled stating 1.5% of their errors led to a patient’s demise.

A Johns Hopkins study determined that an estimated 250,000 patients are killed by medical errors every year. It’s a staggering figure: hospital medical errors are the third leading cause of death in the United States. This equals 700 people per day on average, and has surpassed strokes, Alzheimer’s, and diabetes. There are many casualties when one of these events occurs, the doctors, nurses and health care provider suffer as well. Suicidal ideation doubles in the three months following one, taking a substantial toll on many involved.

Unfortunately, the U.S. has higher rates of medical, medication, and lab errors than comparable countries. In 2016, 19% of patients in the United States experienced a medical error compared to 12% of patients in similar countries. An important question is then why are so many of these errors occurring? In many cases, the issue is not one of negligence by a doctor or other medical practitioner, but rather a systemic issue with the delivery of American health care. The role of health care provider can be stressful, leading to over-worked, “stressed-out” individual, thus more prone to error. In addition, staying abreast of the latest studies and the newest information can be challenging, and not everyone is good about doing so.

Physicians tend to be creatures of habit. We learn a way of doing things, and that is what we are comfortable with. Because medical information is always changing, sometimes old practices are improved upon. For example, let’s look at the treatment of gout, a problem where the big toe joint (usually) suddenly becomes red, swollen, and extremely painful. For many years, we have had an excellent treatment for the acute attack, a drug called colchicine. This drug is highly effective at stopping the process which is a gout attack.

An anti-inflammatory has also long been prescribed, due to the severity of the pain. Decades ago, we had far fewer choices for these mild, pain-relieving medications. Indomethacin was one of them, but had significant side effects. Still, with so few options, this drug was successfully utilized in the treatment of gout. Even though it has no special effects or properties when it comes to gout, it became synonymous with the treatment regimen for an acute attack of this intensely painful problem. But instead of switching to one of the newer and safer anti-inflammatories, many doctors continue to prescribe indomethacin despite the plethora of choices. Interestingly, nowhere else is this drug prescribed.

Errors in treatment can occur for many reasons. One of the most common are incorrect or inaccurate diagnoses. Some obvious ramifications are delayed, omitted, or inappropriate medical treatments. Naturally, when any method of care is not appropriate, and the treatment plan ill-advised, there has been a medical error and harm can occur. When some condition could have been prevented but weren’t, the same applies. Predictably, some mistakes can be made during surgical procedures. What about hospitals? They are large, complex productions, with plentiful opportunity for error. Mistakes also are made in the prescribing and dispensing of medication, occurring too often in hospitals and pharmacies. Last but not least, equipment fails as well.

Our system of care is fragmented. Many moving parts, with inadequate, outdated methods of communication. EHR systems, Electronic Health Records, were a federally mandated program a decade ago, with claims it would rectify the communication problems. But the systems generally can’t communicate and so are not much better than paper. Communication and administrative errors are often the result.

But any tools that enable patients to manage their health-care needs will be beneficial. There are ways patients can better protect themselves. One is to bring someone else, to act as your health advocate. A vast amount of information may be relayed at a visit and your advocate can help to retain and understand some of that. When you are the patient, it can be difficult to have good listening skills. An advocate can help, also asking pertinent questions.

Medical mistakes are a huge problem, amongst the public, health administrators and lawmakers alike. Finding solutions has been a challenging task, but one highly sought. We have a health care system which is complex and has been difficult to change. Naturally, the financial investments involved make real change hard. Perhaps continued improvements in technology will enhance the use of data provided by electronic health records.

Regardless of this hope, the occurrence rate of errors in medicine remains too high. Consequently, one needs to be your own health advocate, asking questions as appropriate. But when there are few alternatives to your health care choices, the situation changes and other options may be rare. Regardless, we must strive to do better, so efforts will continue to reduce the occurrence of medical errors. Until then, think critically about your options. Be thoughtful, be informed, about your medical care. Our lives depend on it.