The doctor will see you now.

According to the U.S. Centers for Disease Control and Prevention, the top two causes of death are heart disease & cancer (in 2013, 611,000 and 585,000 deaths respectively). What’s the #3 killer today? The answer may surprise you.

First do no harm.

Iatrogenesis, meaning “brought forth by a healer” (from the Greek iatros for healer) is an inadvertent adverse effect or complication resulting from medical treatment or advice. Examples include inadequate patient evaluation, lack of monitoring and follow-up, failure to perform necessary tests, and adverse effects associated with exposure to prescription drugs and medications. Not to mention the occasional misplaced sponge.

Medical errors take the bronze.

Each year, approximately 12 million adults who seek outpatient medical care are misdiagnosed, according to a Johns Hopkins study published in the journal BMJ Quality & Safety (2016). Previous research focused primarily on hospital patients, but this study, which analyzed medical death rate data over an eight-year period, suggests a large number of patients are being misdiagnosed in outpatient clinics and doctors’ offices. In half of those cases—an estimated 6 million outpatients per year—the misdiagnosis had the potential to result in severe harm. Their conclusions are serious:

10% of all U.S. deaths are now due to medical error.
More than 250,000 deaths per year are due to medical error.
Medical errors are an under-recognized cause of death.

The study’s findings suggest that medical errors are now the third leading cause of death in the U.S., surpassing respiratory disease, which kills close to 150,000 people per year. Pardon the pun podiatrists, but something smelly is afoot.

Physician, heal thyself.

Of course, no one is completely immune from error and some poor outcomes are inevitable. Researchers caution that most medical errors aren’t due to inherently bad doctors—a study in the New England Journal of Medicine (2016) reported that 1% of physicians accounted for 32% of paid malpractice claims over the past 10 years. Rather, systemic problems such as poorly coordinated care, incompatible insurance networks, and the absence or underuse of safety nets and other protocols all but guarantee screw ups.

Furthermore, doctors no longer control how medicine is practiced. Decisions are often dictated by hostile patients, insurance company drones who second-guess their medical judgment, administrators pushing 10-minute office visits, government bureaucrats peering over their shoulder, and trial lawyers circling overhead. No wonder a survey found 57% of 1,175 doctors questioned would not recommend the field to their children.

What’s up doc?

NeXters, there is much that you can do to improve your chances for a correct diagnosis:

Take responsibility. The practice of medicine is as much art as science, yet we still have a paternalistic model that states if something goes wrong it’s your doctor’s fault. Ultimately, you are responsible for managing your health care.
Do the homework. According to Pew Internet & American Life Project (2013), one in three American adults have gone online to figure out a medical condition. Half said the info they found led them to think they needed the attention of a medical professional.
Spill your guts. Explain your medical history to the doctor in a clear, chronological way. Don’t forget to share details of your family’s medical history, such as a parent with cancer, which may be useful information for the doctor to take into consideration.
Get a second opinion. Medical decision-making is fraught with inherent subjectivity and physician judgment is highly variable (see: Scientific American, 2011). Very different conditions exhibit similar symptoms (your humble author experienced this first-hand).
Use common sense. Your doctor is trained in medicine. You are not. Do what he or she tells you and be sure to check on all test results. Don’t assume that if you don’t hear anything it’s good news. No news is not necessarily good news.

There is no question that modern medical practices are remarkable, often effective, and occasionally miraculous. Bear in mind, however, that although physicians are well schooled in their protocol, MD is not an acronym for “Medical Deity.” If your sawbones gets it wrong, you’ll have to live with the consequences.