By Mandy Oaklander
May 3, 2016

Heart disease, then cancer are the leading causes of death for Americans. Chronic lower respiratory diseases like bronchitis and emphysema take third place, according to leading health groups. But that spot really belongs to a cause of death that doesn’t even make the current list, according to a new paper published in The BMJ. The third-most deadly killers of Americans are medical errors, accounting for more than 250,000 deaths each year, the analysis says.

“Collectively, the problem of medical care gone wrong kills a substantial number of people in the United States,” says Dr. Martin Makary, a surgeon and professor of health policy and management at the Johns Hopkins University School of Medicine. Makary and his colleague looked at four studies analyzing U.S. death rate data and determined that about 9.5% of all deaths result from medical errors.

Medical errors encompass a range of potentially harmful mistakes a provider or hospital system could make: misdiagnosis, administering the wrong dosage of a medication or neglecting the care of a patient because of a communication breakdown. Errors like these can be benign, but they can also cause people who have otherwise long life expectancies to meet an untimely death.

On a death certificate, a person’s cause of death is recorded by a billing code, and medical errors aren’t on the list of options, Makary says. That means deaths by medical error are being classified in other ways, and medical errors aren’t being counted by national statistics that determine threats to the health of Americans—and therefore the funding priorities for research.

“In the old school of medicine, it was not well recognized that people actually die from the care that they receive rather than the disease or illness for which they seek care,” he says. Now, a strong body of scientific literature documents the role of medical errors and the importance of patient safety, and “we should have a more open and honest conversation about the problem,” he says.

Contact us at editors@time.com.

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