"Healthcare System Problems: Why Time Pressure Leads to Fatal Medical Errors"

The Silent Killer in Healthcare: How The System’s Time Pressure Kills More Than Disease

The claim is stark, shocking, and demands attention: medical error is estimated to be the third leading cause of death in the United States, surpassing well-known killers like cardiovascular and cancer. 

While this figure is often used to indict the medical profession, a deeper look reveals a more insidious culprit: a healthcare system that pressures doctors into hurried, hyper-efficient visits, ultimately sacrificing patient safety and preventative care on the altar of productivity. The problem isn't the doctor; it's the system (the time constraints placed by the insurance, medicare and profitability). 

The Data: Medical Errors vs. Diabetes Mortality

To understand the scale of this concern. we must look at the data from two different reporting systems:

Cause of Death	Estimated Annual Deaths (U.S.)	Source & Year of Data
Medical Error	251,454	Johns Hopkins/BMJ Study (2016, based on 2013 data)
Diabetes	95,190	CDC National Center for Health Statistics (2023  data)

The landmark 2016 study by Johns Hopkins researchers, published in The BMJ, calculated that approximately 251,454 deaths per year are attributable to medical error, placing it third behind heart disease and cancer. This number is more than 2.6 times the number of deaths officially attributed to diabetes (95,190 in the most recent CDC data).

The key distinction is that deaths from medical error are often not recorded as such on death certificates, which rely on the International Classification of Diseases (ICD) billing codes. This systemic failure to track iatrogenic (treatment-caused) harm means the scale of preventable death is vastly underestimated in official statistics.

The Root Cause: The Tyranny of the 15-Minute Visit

When was the last time you saw your primary health care provider? How much face to face time did you have with them? Not assistant taking your vitals but the provider?

The single largest factor driving these preventable errors is the crushing time constraint placed on primary care physicians. The average length of a primary care visit in the U.S. is often cited as being between 13 and 24 minutes, which may be true if it’s including the time the medical assistant or nurse takes your vitals and reason for appointment.  I am often told it more like 5-7 minutes.

In this brief window the provide is expected to cover a staggering list of tasks:

1.Reviewing electronic health records (EHRs).

2.Addressing the patient's chief complaint.

3.Performing a physical exam.

4.Developing a treatment plan.

5.Documenting the entire encounter for billing and legal purposes.

As a result, doctors are forced into a high-stakes triage, often leaving little to no time for the most critical, yet time-consuming, aspects of care. And this is only for ONE chief complaint but most patients have more than on health issue. 

WHY YOU ARE NOT GETTING WHAT YOU NEED FROM YOUR PROVIDER

1. The Failure to Listen (Diagnostic Errors)

Rushed visits lead to diagnostic failures. When a doctor is constantly looking at the clock or the computer screen, they miss subtle, non-verbal cues and fail to ask the probing follow-up questions that can uncover the true nature of a patient's illness. Studies have shown that when physicians feel time-pressured, they are more likely to rely on pattern recognition and less likely to engage in the thorough, patient-centered dialogue necessary for accurate diagnosis.

2. The Absence of Lifestyle Recommendations

Diabetes, heart disease, and many other chronic conditions are fundamentally driven by lifestyle factors. The most effective "medicine" for these diseases is often not a pill, but a detailed, personalized plan for diet, exercise, and stress management. This sounds like Functional Medicine. 

However, providing meaningful lifestyle counseling—the kind that truly changes patient behavior—requires time: time to educate, time to listen to the patient's barriers, and time to develop a realistic, collaborative strategy. When a visit is capped at 15 minutes, this crucial conversation is often reduced to a cursory, ineffective instruction to "eat better and exercise more," or is skipped entirely in favor of prescribing a medication. This failure to address the root causes of chronic disease directly contributes to the mortality statistics we are trying to reduce.

This is why we offer workshops and masterclasses in our practice because we certainly can’t share the 30+ years of knowledge in a single visit. 

THE SYSTEM, NOT THE INDIVIDUAL

It is vital to recognize that this is a systemic problem, not a failure of individual doctors. Physicians are often victims of the same system, suffering from burnout and moral injury as they are forced to compromise their professional integrity by providing suboptimal care due to institutional demands for higher patient volume.

The current fee-for-service model incentivizes volume over value, rewarding the number of patients seen rather than the quality of the outcomes achieved. Until this model is fundamentally shifted to one that values time spent listening and educating as much as it values procedures and prescriptions, medical error will continue to be a silent, yet devastating, leading cause of death in the U.S.

That’s why Functional Medicine will be the new frontier of health care.

References

1.Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, 353. Link to BMJ Abstract

2.Centers for Disease Control and Prevention, National Center for Health Statistics. (2023). FastStats: Deaths and Mortality. Link to CDC Data (Data for 2023)

3.Tai-Seale, M., McGuire, T. G., & Zhang, W. (2007). Time allocation in primary care office visits. Health Services Research, 42(5), 1871–1894. Link to PMC Abstract

4.Konrad, T. R., Link, C. L., Shackelton, R. J., & Marceau, L. D. (2010). It's about time: Physicians' perceptions of time constraints in primary care medical practice in three national healthcare systems. Medical Care, 48(2), 154–161. Link to Journal Abstract

5.Nguyen, M. L. T., et al. (2024). Primary Care Physicians' Experiences With and Strategies for Addressing Time Constraints. JAMA Network Open, 7(5):e2411604.