Quarterly Letter: The Best Safety Value
In an article in a recent issue of the Journal of the
American Medical Association (Vol. 284, No. 4) "Is U.S.
Healthcare Really the Best in the World?" Dr. Barbara Starfield, an
eminently respected researcher from Johns Hopkins in Baltimore
notes that medical misadventure is the third leading cause of death
in the country after cancer and heart disease. Dr. Starfield points
out the following annual mortality statistics:
- 12,000 deaths from unnecessary surgeries and invasive
- 7,000 deaths from in-hospital medication errors
- 20,000 deaths from other in-hospital errors
- 80,000 deaths from nosocomial infections
- 106,000 deaths from non-error adverse effects of medications
Dr. Starfield attributes the relatively poor health status of Americans, compared with other countries that spend substantially less on healthcare, to a weak and poorly organized primary care system. Dr. Starfield argues that the U.S. system promotes the overuse of diagnostic and therapeutic interventions with the harmful results seen above. She calls for research to better understand the consequences of intensive and aggressive healthcare delivery. Could it be that our struggling system with its line-ups for procedures and slow approval of new drugs is actually protecting the health of Canadians? The next time healthcare funders face a demand for a new cath lab or an addition to the drug formulary, they may want to invest the money more appropriately in primary care renewal instead.
About the Author(s)
Walter Rosser, MD, MRCGP(UK), CCFP, FCFP, Past-President,Ontario College of Family Physicians
Jan Kasperski, RN,MHSc, CHE, Executive Director,Ontario College of Family Physicians
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