How Scared Should I Be of Hospitals?

In the column "How Scared Should I Be?" VICE staff writer and generalized anxiety disorder sufferer Mike Pearl seeks to quantify the scariness of everything under the sun. We hope it'll help you to more wisely allocate that most precious of natural resources: your fear.

I've always liked hospitals in a way. They're clean, well-lit places, where smart people rush around trying to fix problems with modern technology.

But being in the hospital is hell. You surrender all power and turn into a prop, to be dealt with by people who are at work. They calmly break your skin, and think nothing of looking at your genitals or your shit. The whole experience is mostly just waiting for something interesting to happen, which means bouncing back-and-forth between boredom and creeping menace. And the whole time you're surrounded by the beeps and whirrs of machines that sound unmistakably like a TV character's death.

Fear of hospitals is visceral. It needs no explanation. But there are real risks involved in being at a hospital. Some, like waking up during surgery, can't be prevented by worrying. But steps can be taken to avoid some things, such as bacterial infections. So is there such a thing as a healthy fear of hospitals that we should actively cultivate?

Bacteria should definitely be on your mind, because hospitals are crawling with them, according to Dr. Cliff McDonald, the associate director of science at the Center for Disease Control's healthcare quality promotion branch. "To die from a healthcare associated infection," he told VICE, is "probably more likely than dying in a car accident."

The CDC's numbers are deeply unsettling, beginning with the number of deaths annually, which is around 75,000—just a little shy of the 88,000 who die from drinking too much every year.

"On any given day in the hospital," McDonald told me, "one in twenty-five [patients] will have infections ongoing." He added that that statistic means that, in US hospitals, there are around 722,000 infections a year.

But in a bit of good news, those numbers actually show an improvement over past reports. The World Health Organization sounded the alarm about this back in 2011, finding that at the time, American hospitals were exceptionally lethal, with patients acquiring 1.7 million infections per year, 100,000 of which were fatal. Meanwhile, in Europe—a place with a little more than twice the population of the US—there were 4.5 million infections per year, and only 37,000 of those resulted in the patient's death.

The worst of these infections are ones that can't be treated with antibiotics. McDonald pointed to Clostridium difficile (C. diff), which causes painful, sometimes fatal diarrhea, and Methicillin-resistant Staphylococcus aureus (MRSA,) a flesh-eating bacteria that can kill you, or at least end your NFL career. But hospital-acquired MRSA is on somewhat of a decline. The CDC's most recent report on MRSA shows a 13 percent decrease in cases observed between 2011 and 2014.

In addition to bacteria, when you're in a hospital, you're also at risk of acquiring a virus—and not just a case of hospital-acquired sniffles. "I hate to say it," McDonald said, "but even in highly developed healthcare delivery settings like ours, there have been major lapses in injection safety." For instance, the reuse or improper treatment of needles has been spreading hepatitis around American hospitals this year, particularly among kidney dialysis patients.

And while you can wash your hands to decrease your exposure to bacteria, there's really nothing you can do about hepatitis on a needle, according to McDonald. "I don't think we have a lot of patient advice in terms of how they should act with their physician over the use of multidose vials," he said. "That's a little bit beyond most patients."

To make matters worse, deaths from such medical mistakes aren't properly tallied by the CDC, according to a team of advocates including Johns Hopkins surgeon Dr. Martin Makary. And the distortions conceal a terrifying reality, if the open letter those advocates published online two months ago is correct: Mistakes—which include misdiagnoses, systemic flaws that cause a death, some other kind of preventable failure, or an "error in judgment, skill or coordination" (a.k.a. "whoops")—are a leading cause of death.

Specifically, the letter claims, 9.7 percent of all deaths in the United States come from medical mistakes—making medical mistakes the third ranking cause of American death. Just behind heart disease and cancer.

But while it doesn't currently tally mistakes to Makary's satisfaction, the CDC knows about them. "There are some things we recommend," McDonald said. "Certainly, if you can bring a friend in with you to act as an advocate, we recommend that," he said, adding that you should, "ask questions, and talk to your doctor."

Hospitals in the US are better than the alternatives, I suppose (Mafia doctors? Euthanasia?) particularly when you consider that in the developing world, one-third of hospitals don't have running water.

But of course the scariest thing of all about hospitals is that there's a 40.3 percent chance that I will eventually die in one, and that goes for you too.

Follow Mike Pearl on Twitter.