Delays in diagnosis, forgotten equipment, examinations prescribed too late, nosocomial infections… In nearly 25 years of legal expertise, the former neurosurgeon at the Ile-de-France hospital Bicêtre (AP-HP) Marc Tadié has seen hundreds of files from victims of medical incidents. Some dramatic stories that this expert from the National Commission for Medical Accidents decided to recount in a shocking book entitled “The Scandal of Medical Accidents” (Éditions le Cherche Midi). An edifying investigation, where he points out the culture of silence among doctors, the structural failures of the health system and warns of the urgency to act.
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What motivated you to investigate medical accidents?
This is the number of medical errors and especially their repetition for the same causes. Around 15 million hospitalizations per year in France involve a patient who is the victim of a medical error, this is one in forty cases of treatment. Knowing that simple measures could be taken to avoid at least half of them also reinforced my project.
“We need a culture of safety”
You base your analysis on moving stories experienced by patients. Did some strike you more than others?
All of them are significant when it comes to a serious disability or a death that could have been avoided. Recently the case of two young people, operated on in different places for a benign tumor, shook me deeply. Due to a technical error during the intervention, both are now heavily paralyzed. They can no longer express themselves except by blinking their eyes for one and moving an index finger for the other. It’s absolutely terrible!
The range of medical accidents is wide. Are they clearly defined in the medical field?
They’re officially called serious adverse health care events. To err is human, of course, but it shouldn’t exist. We have the means to avoid them, but a large majority of incidents go unreported. Medical accidents are considered fatal. Result: we do not look at their causes, nor at the measures to be deployed to avoid them, as is done in civil aviation after an air accident.
“The equivalent of a Boeing crashing every two days”
You estimate that these accidents are responsible for 30,000 deaths, how did you arrive at this estimate?
Extraordinary coincidence, at the same time as the release of my book, an edifying report from the Court of Auditors pointed out a massive under-declaration of medical errors. The financial jurisdiction’s estimates corroborate mine: there are between 175,000 and 300,000 serious adverse events per year in France. In the absence of a centralized national register, the range is wide. The only precise data is that the Court of Auditors mentions 4,600 deaths from nosocomial infection per year. It’s more than road accidents! For me, this is underestimated: infectious disease specialists are talking about 10,000 deaths.
And medical accidents are not limited to nosocomial diseases. We must also take into account medication errors (dosage, interaction, prescription, monitoring) which cause the premature death of around 10,000 people per year, diagnostic errors (5,000 to 10,000 deaths) and technical errors and post-operative follow-ups in surgery. (between 5 and 7,000 deaths). If we add up the problems linked to psychiatry, obstetrics, and the damage suffered by the patient himself during his course of care, we arrive at the 50,000 deaths mentioned by victims’ associations. The figure of 30,000 dead seems to me to be closer to reality. Which is huge. This is the equivalent in deaths and injuries of a Boeing that crashes every two days.
However, the reporting of these incidents has been mandatory since a 2018 law…
There is no culture of safety in the medical environment. It is neither taught in the faculty of medicine nor in conferences. We are moving from a logic of total absence of notion of security to a logic of guilt. An establishment, a doctor or a caregiver at fault will therefore tend to keep it quiet. There is a form of general omerta. In England, an establishment that does not report adverse events is immediately inspected. Not in France. A hospital service which records a lot of accidents and medical errors will tend to hide them so as not to be under the spotlight of the Regional Health Agency.
“Victims must report”
Do victims speak more easily?
In a majority of victims, there is some form of fatality. Those who dare to ask for explanations often find themselves facing a wall of silence or even a wall of accusations. They sometimes end up feeling guilty themselves and don’t go any further.
However, patients have access to the national medical error reporting portal. It is absolutely necessary for people who think they are victims to know that they can report it online. This is perhaps the only way for things to change and for us to have data that truly reflects reality. I am not encouraging an increase in complaints, but I am encouraging this report to be made, which is neither an accusation nor legal action. Saying it can prevent this from happening again.
You talk about “simple measures” applicable tomorrow to reduce the number of medical accidents. That is to say?
It is absolutely necessary to reform the activity pricing system. We must also re-establish downstream beds to keep people at risk under observation and not send them home when emergency rooms are saturated. Another immediately applicable measure: monitoring protocols must be established in emergency rooms and in departments with artificial intelligence software. It is also urgent to facilitate communication between practitioners. A directory of specialists who can be reached at any time for advice would be of great help to emergency physicians who are often alone in their decision. Finally, it is urgent to enforce protocols in the operating room: 40% of these checklists to prevent infections are not respected.
“L’IA, copilot du medecin”
How can AI reduce medical errors?
Studies have shown that in terms of safety, a caregiver with artificial intelligence obtains better results than a practitioner alone. The AI must become the doctor’s co-pilot. For example in intensive care, good software can identify what we call weak signals allowing us to act more quickly. We can also imagine equipping nurses’ trolleys with an AI monitoring system. We would save a lot of time and safety. For example, this technology would make it possible to avoid missing a complication by reminding caregivers that tingling in the legs requires an immediate MRI check to avoid any risk of hematoma which could paralyze a patient. Or that a sudden headache can be a sign of hemorrhage and that a CT scan is essential.
Why is none of this implemented?
It takes a will. It depends on the doctors. We must generally achieve a culture of safety with continuous training and a safety label. We must convince the medical community to analyze its errors and do everything possible to ensure that they do not happen again. Some doctors are ready to do so, but we must give them time to do so. Patients also have their role to play: they must be active in their health and dare to ask questions during their care journey.
“A strong political reaction as for Road Safetyâ€
You also point the finger at the training of doctors…
As the Court of Auditors points out, to remedy the medical deserts, the level of examinations has been gradually lowered: we must restore the requirements. In the past, comprehensive training was provided to doctors so that they had knowledge of all pathologies. Given the complexity of diagnoses, medicine has become more specialized. We must re-establish this basic training for everyone: emergency doctors, general practitioners and specialists. Doctors must also update themselves, because progress in medicine is so rapid that we can quickly be left behind. Imagine an airline pilot who is not trained in the latest technological advances, how can he continue to fly?
How did we get here?
At the origin of medical error, there is always human error. But this is terribly favored by a degraded health system. These are structural failures. Since 1975, from year to year, and from reform to reform, the daily practice of medicine has become more and more complicated. This context favors medical accidents.
The laudable establishment in 2002 of the National Office for Compensation for Medical Accidents (Oniam) has had perverse effects. We compensate, we no longer look for the culprit. We must stop these excesses which consist of covering up accidents and paying for the damage, instead of learning from them. Doctors must no longer consider them as inevitable and feel guilty: they must fight to avoid these failures.If all disciplines take the problem head on, as anesthesia and resuscitation have done, we will move forward. After the damning report from the Court of Auditors, I do not understand why there is not a strong political reaction. A reaction such as that of Jacques Chirac for Road Safety.
