Medical error may be the third cause of death in the United States, just behind cancer and heart disease, but we can’t be sure thanks to a flaw in the reporting system that tracks such things.

Martin Makary and Michael Daniel of Johns Hopkins University School of Medicine hope to change all that, as they explain in their analysis of the system used by the U.S. Centers for Disease Control and Prevention (CDC). At issue is the fact that while the CDC compiles an annual list of the most common causes of death in the United States, they use data from death certificates that rely on the assignation of an International Classification of Disease (ICD) code to the cause of death. The problem with this system, according to Makary and Daniel, is that it does not capture “human and system factors” such as communication breakdown, diagnostic error, poor judgment, and inadequate skills.

Makary and Daniel arrived at this conclusion after analyzing data from studies going back to 1999 and extrapolating to the total number of U.S. hospital admissions in 2013. The results were a mean rate of 251,454 deaths from medical error per year. When they compared this estimate with data from the CDC, medical error emerged in third place as the most common cause of death in the U.S. . Their findings were released in the British Medical Journal in May 2016.

While this is only an estimate, that fact alone points to the need to measure the consequences of medical care on patient outcomes, especially if the data places those consequences as the third leading cause of death. Mackey and Daniel suggest three steps hospitals and physicians can take:

1. Follow principles that take human limitations into account to reduce frequency.
2. Create high visibility of human errors in order to reduce repetition and mitigate future damages.
3. Have remedies on hand to rescue patients compromised by human error.

They also call for inclusion of an extra field on death certificates that would require a signer to indicate whether a preventable complication stemming from the patient’s medical care contributed to the cause of death.

“Sound scientific methods, beginning with assessment of the problem, are critical to approaching any health threat to patients,” they write. “The problem of medical error should not be exempt from scientific approach.”  Further, Mackey and Daniel believe that recognizing the role of medical error in patient death “will guide both collaboration and capital investment in research and prevention.”

As a comment, and without disputing the good intentions of the researchers and the numerous lives that could be saved by learning from mistakes, it must be recognized that in our litigious environment, the admission of medical errors will inevitably lead to more successful lawsuits by the victims. Furthermore, acknowledging one’s faults is not a natural propensity of human beings, even doctors. Or is it? At the same time, and if medical errors are indeed a frequent cause of death, then tackling them is a challenge that the life insurance industry cannot afford to ignore.