Strengthening the Medical Error “Meme Pool”

  • Benjamin L. MazerEmail author
  • Chadi Nabhan


The exact number of patients in the USA who die from preventable medical errors each year is highly debated. Despite uncertainty in the underlying science, two very large estimates have spread rapidly through both the academic and popular media. We utilize Richard Dawkins’ concept of the “meme” to explore why these imprecise estimates remain so compelling, and examine what potential harms can occur from their dissemination. We conclude by suggesting that instead of simply providing more precise estimates, physicians should encourage nuance in public medical error discussions, and strive to provide narrative context about the reality of the complex biological and social systems in which we practice medicine.


medical error patient safety quality improvement media 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on. Lancet 2017;390:415–23. doi: CrossRefPubMedGoogle Scholar
  2. 2.
    Steinhubl SR, Topol EJ. Moving from digitalization to digitization in cardiovascular care: Why is it important, and what could it mean for patients and providers? J Am Coll Cardiol. 2015;66:1489–96. doi: CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Freund Y, Goulet H, Leblanc J, Bokobza J, Ray P, Maignan M, et al. Effect of systematic physician cross-checking on reducing adverse events in the emergencydepartment: The CHARMED cluster randomized trial. JAMA Intern Med. 2018;178:812–9. doi: CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Solomon AJ, Corboy JR. The tension between early diagnosis and misdiagnosis of multiple sclerosis. Nat Rev Neurol. 2017;13:567–72. doi: CrossRefPubMedGoogle Scholar
  5. 5.
    Choo E. Fox’s new drama ‘The Resident’ makes doctors into villains. That’s not just bad TV, that’s dangerous., NBC News THINK. 2018 Feb 13. Available at Accessed 15 Mar 2019.
  6. 6.
    3759Films. To Err is Human: A patient safety documentary. Available at Accessed 15 Mar 2019.
  7. 7.
    Hunter C, Obradovich K, Dominick A, Doak R, Laird R. Iowa child’s death begs for medical transparency. Des Moines Register. 2018 Mar 20. Available at Accessed 15 Mar 2019.
  8. 8.
    Newman DM. Sociology: Exploring the architecture of everyday life. 12th ed. Thousand Oaks: SAGE Publications; 2018:256.Google Scholar
  9. 9.
    Sanders B. Medical mistakes. Available at Accessed March 15 2019.
  10. 10.
    James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9:122–8. doi: CrossRefPubMedGoogle Scholar
  11. 11.
    Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016;353:i2139. doi: CrossRefPubMedGoogle Scholar
  12. 12.
    Carivate Analytics. Web of Science (Core Collection). Available at 15 Accessed March 2019.
  13. 13.
    The BMJ. Most read. Available at Accessed 13 March 2019.
  14. 14.
    Jamieson KH. Crisis or self-correction: Rethinking media narratives about the well-being of science. Proc Natl Acad Sci U S A. 2018;115:2620–7. doi: CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Shojania KG, Dixon-Woods M. Estimating deaths due to medical error: the ongoing controversy and why it matters. BMJ Qual Saf. 2017;26:423–8. doi: CrossRefPubMedGoogle Scholar
  16. 16.
    Dawkins R. The Selfish Gene. 2nd ed. Oxford: Oxford University Press; 1990.Google Scholar
  17. 17.
    Gianoli GJ. Medical error epidemic hysteria. Am J Med. 2016;129:1239–40. doi: CrossRefPubMedGoogle Scholar
  18. 18.
    Hall MJ, Levant S, DeFrances CJ. Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000-2010. NCHS Data Brief. 2013:1–8. Available at Accessed 15 Mar 2019.
  19. 19.
    Tversky A, Kahneman D. Judgment under uncertainty: Heuristics and biases. Science 1974;185:1124–31. doi: CrossRefPubMedGoogle Scholar
  20. 20.
    To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington, DC: National Academies Press; 2000.Google Scholar
  21. 21.
    Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med. 2010;363:2124–34. doi: CrossRefPubMedGoogle Scholar
  22. 22.
    Hogan H, Zipfel R, Neuburger J, Hutchings A, Darzi A, Black N. Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis. BMJ. 2015;351:h3239. doi: CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Rogne T, Nordseth T, Marhaug G, Berg EM, Tromsdal A, Saether O, et al. Rate of avoidable deaths in a Norwegian hospital trust as judged by retrospective chart review. BMJ Qual Saf. 2019;28:49–55. doi: CrossRefPubMedGoogle Scholar
  24. 24.
    Gill JR, Ely SF, Toriello A, Hirsch CS. Adverse medical complications: an under-reported contributory cause of death in New York City. Public Health. 2014;128:325–31. doi: CrossRefPubMedGoogle Scholar
  25. 25.
    Sainato M. Why America’s nurses are getting ‘hangovers’ from their work. The Guardian. 2019 Feb 12. Available at Accessed 15 Mar 2019.
  26. 26.
    Blendon RJ, Benson JM, Hero JO. Public trust in physicians--U.S. medicine in international perspective. N Engl J Med. 2014;371:1570–2. doi: CrossRefPubMedGoogle Scholar
  27. 27.
    Jones AH. Tweet: “There are always debates and we welcome them. Doctors are threatened. I’m glad. They are the third leading cause of death and hospitals are overbilling humans in pain. Patient safety activists are in my corner and I’m fine with that”. Twitter. 2018 Feb 5. Available at Accessed 15 Mar 2019.

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of Pathology Yale University School of MedicineNew HavenUSA
  2. 2.Aptitude HealthAtlantaUSA

Personalised recommendations