In a book presented as a major exposé, Marc Tadié, MD, PhD, former head of the neurosurgery department at Bicêtre Hospital and court-appointed expert in Paris, France, described how systemic factors may have contributed to medical accidents and how authorities may have attempted to conceal their extent.

From the title The Scandal of Medical Accidents, the tone is clear. In the book, Tadié noted that such events accounted for “tens of thousands of deaths each year.”

The number of deaths remains uncertain. Tadié acknowledged that providing a precise estimate was difficult, in part because of the underreporting of serious adverse events linked to healthcare. Drawing on figures from several associations, based on multiple studies, the neurosurgeon suggested a figure of 150,000 victims per year, including 30,000 to 50,000 deaths, which would make it the third leading cause of death in France after cancer and cardiovascular disease.

However, according to Tadié, the exact figure was not necessarily the key issue. “The tragedy is that (and this is a figure on which everyone agrees) more than half of medical accidents could be avoided through simple and easy to implement measures.”

Error Drivers

Tadié attempted to identify these “simple measures,” beginning with an analysis of the causes of medical accidents. He adopted a narrative approach, recounting several typical cases through short clinical vignettes: an emergency physician who refused a CT scan for a child with a head injury who later died from an intracranial hematoma; back surgery recommended too early; a psychiatrist who opposed hospitalization for a person with depression who then died by suicide; and a fulminant hospital-acquired infection.

These clinical cases illustrated, each in their own way, different causes of medical accidents: physician overwork and, at times, arrogance, insufficient attention to patient concerns, rushed decision-making, failure to follow official recommendations, and pressure linked to pharmaceutical interests. Surgeons, a specialty to which Tadié belonged, were particularly targeted. In the context of back surgery, some were accused of recommending procedures to patients who did not require them.

“While errors almost always stem from an isolated act or personal negligence, they are in fact often the result of a complex interaction between human factors and failures in the healthcare system,” Tadié stated. 

He argued that the healthcare system, and more specifically, its evolution over recent decades, was the primary driver of the apparent increase in medical errors.

Tadié also outlined several systemic changes that, in his view, contributed to this trend. He pointed to shifts in medical education, which he described as an insufficient focus on clinical practice and mentorship. He also highlighted activity-based hospital funding, which encouraged faster patient turnover and contributed to premature discharge decisions with limited follow-up. More broadly, he described increasing hospital bureaucratization as illustrated by the consolidation of departments into larger clusters. “A hospital subjected to a logic of profitability, departments under constant pressure, understaffed teams, drastically shortened hospital stays, and a medical hierarchy called into question: All of these factors increase the risk of error,” he explained.

Culture Shift

Framing the issue as a public health crisis, the neurosurgeon denounced what he described as a “code of silence” among health authorities, summarized in the phrase “silence, we pay.” He argued that the development of insurance mechanisms and the establishment of the National Office for Compensation for Medical Accidents may have contributed to normalizing medical accidents and making them appear unavoidable. Physicians, often reluctant to acknowledge errors, were described as key contributors to this code of silence, which may limit accountability. According to Tadié, this lack of transparency hindered the examination of underlying causes and contributed to the recurrence of such events. 

Tadié concluded his book by outlining several proposals that he believed could reduce the number of medical accidents in France. He called for the emergence of a genuine “culture of safety” within the healthcare system, drawing inspiration from practices in aviation, where detailed analyses of air accidents have led to a substantial reduction in their occurrence. Every medical accident should be reported without exception and assessed through a mortality and morbidity review, he said.

He also called for an end to impunity, stating that the physician responsible for an abnormally high number of medical accidents should be removed from the medical register. The neurosurgeon also expressed the view that AI may help reduce the risk of medical errors in the future.

This story was translated from JIM, part of the Medscape Professional Network.