Fact-Checker to the O.R.!

You ask why I have this red and white ribbon pinned to my lapel. Well, a pink ribbon, as you know, stands for breast cancer awareness, and a solid red one signifies concern about AIDS, but I had to design this red and white one myself to call attention to the medical error epidemic.

The National Academy of Science's Institute of Medicine reported at the end of November that 44,000 to 98,000 people die every year as a result of medical errors--which beats breast cancer, AIDS, car accidents, diabetes, and pneumonia. And that's just the number of victims in hospitals. If we had good stats on the number of people killed by medical errors in other settings--nursing homes and day-surgery centers, for example--the toll would probably be right up there with lung cancer and stroke. Adding insult to grievous bodily injury, there are no criminal penalties for medical errors. Docs who poison and maim may have to pay higher malpractice insurance premiums, but they're as entitled to their fees as those who actually help.

Everyone's taking this much too calmly. People who would never think of lighting up a cigarette or chomping down on a double cheeseburger blithely go on visiting doctors and swallowing prescription drugs.

Where is the medical error equivalent of ACT-UP, which could stand, in this case, for Action to Control the Travesties of Uninformed Physicians?

Who is organizing a Walk for Life to demand a "cure" for medical error?

Why is there no MADD--Mothers Against Destructive Docs?

Maybe we're just getting inured to the error-full way of life.

NASA mixes up centimeters and inches and sends its first Mars Polar Lander to a fiery death--and they have no idea where the second one went.

The frontrunning Republican Presidential candidate thinks that Pakistan's head of state is named "General" and describes the military coup that put him in power as a free election.

President Clinton bombs a Sudanese pharmaceutical plant thinking it was manufacturing biological weapons; he bombs Pakistan thinking it was Afghanistan. And what about the bombing of the Chinese embassy in Belgrade?

As in that case, we must ask whether all of these fatal medical errors are actually mistakes--meaning that the appropriate charge would be manslaughter--or something more akin to homicide. We know what the doctors would say: "Hey, so I thought it was the left kidney when it was really the right kidney that had to come out. You try telling left from right when you're wearing a mask, breathing anesthesia-scented air, and inwardly contemplating the NASDAQ's next move!"

But there is reason to believe that doctors bear a high level of malice toward their patients. If you are over forty or, worse yet, fifty, they will invariably want to sodomize you on sight, either digitally or with lengthy tubes designed for this purpose. If you are female, they will want to take that most sensitive pouch of tissue, the breast, and crush it between two metal planes until you scream. Then they take a picture--ostensibly an X-ray of the breast but more likely a snapshot of your face in agony--to enjoy as part of the slide show at their next annual radiology dinner. And don't forget chemotherapy, which renders the patient shrunken, bald, trembling, and nauseated long before the cancer (assuming there actually is one and the diagnosis was not itself an "error") gets a chance to inflict a single symptom.

All this was on my mind a week or so ago as I approached the date on which I was to undergo surgery. Nothing very gripping, just a bunion-ectomy on my right toe. But still I felt a cold chill when I called the doctor's office to check on the time of this event and heard the answering message assure me that he and his numerous staff were "eager to assist my needs." Assist my needs? My needs don't need any assistance, thank you--they're doing just fine on their own, in fact, growing larger and more insistent every day. What about assisting me? And if he could commit this kind of violence with the English language, what would he do with an actual weapon, a scalpel, for example, in his hand? So I canceled the surgery, feeling as virtuous as if I had just dined on tofu and bulgur wheat, followed by an hour at the gym.

Oddly, no one seems to be thinking about what the medical error epidemic means for health policy. I have friends who rush to the streets whenever an American soldier is placed in harm's way, yet are eager to expand health insurance coverage to the forty-four million uninsured Americans. I know people who treat all of their own ills with echinacea and shark cartilage, but insist that everyone must have equal access to the lethal hazards of the medical system.

What if health care isn't a "right," as we've been saying for years? What if it's more like a blight?

Now I'm sure the medical industry will argue that the number of people cured is far greater than the number killed and possibly even greater than the number of people who would have gotten better by themselves. But we still shouldn't be mindlessly advocating the expanded distribution of what is so often a defective product. We've known for a long time about the deep-rooted racism and sexism of medical care: the bias toward under-treating blacks or sterilizing them without consent, the tendency to view women's illnesses as psychosomatic and their reproductive organs as throw-away parts. Now, in addition to prejudice, add the problems of slovenliness, arrogance, and haste. So there's no excuse for demanding universal health coverage without requiring some immediate reforms.

We could start by taking a lesson from journalism and insert a fact-checker into the medical decision-making process, someone capable of saying on the spot, "Uh, doc, bunions are usually found in the foot region, not in the abdominal cavity."

We could also bring in proofreaders to figure out what those prescriptions really say, or institute mandatory penmanship classes for all pre-meds.

In addition, we should give a greater role to those generally less dangerous "ancillary workers"--nurses, midwives, physical therapists, and physicians' assistants.

And, oh yes, it would help to take the profit out of medicine--at both the physician and HMO level--so there'd be no big incentive to rush maniacally from one patient to the next without bothering to ascertain their names and conditions.

Otherwise forget about expanding health insurance. It would make more sense to create a program of universal life insurance, with added coverage for accidental amputations and excisions of vital organs. At least then, if you fall victim to the medical error epidemic, your family will get something to remember you by, and the doctor won't get a cent. He or she can always fall back on some related profession, like mugging or armed robbery.

Barbara Ehrenreich, author of "Blood Rites: Origins and History of the Passions of War" (Henry Holt, 1997), is a columnist for The Progressive.