The article titled “Why We Still Kill Patients” by Michael L. Millenson, published in the American Journal of Medical Quality, critically examines the persistent and preventable harm that continues to affect patients despite decades of advocacy for patient safety. Millenson explores why well-intentioned health professionals and institutions have made only limited progress in eliminating medical errors that result in death or serious injury.
The author revisits a framework he proposed in 2010—“invisibility, inertia, and income”—to explain the enduring nature of patient harm. “Invisibility” refers to the lack of widespread public awareness and institutional accountability regarding medical errors. Millenson argues that harm remains hidden due to the absence of involvement from prominent disease organizations and the use of complex medical jargon that obscures understanding. He criticizes the avoidance of naming specific hospitals in patient narratives, which further diffuses responsibility.
“Inertia” is described as systemic complacency. Despite widespread acknowledgment of medical harm, health systems often treat it as an unavoidable part of care. Survey data show that hospital leaders and boards still deprioritize patient safety unless prompted by an adverse event. Even seemingly progressive measures—such as hand hygiene requirements—lack the enforcement mechanisms to drive real change.
“Income,” the third element, highlights the tension between financial incentives and moral obligations. Millenson finds it ethically disturbing that efforts to improve safety, such as reducing central-line infections or preventing falls, are often justified only when they prove cost-effective. He contends that life-saving interventions should not be subject to return-on-investment calculations.
In concluding, Millenson emphasizes the urgency of confronting these barriers with honesty. He cites recent efforts such as the Leapfrog Group’s safety scoring system and Medicare’s move to link reimbursement to safety culture as promising developments. However, he warns that these measures are insufficient without a deeper cultural shift in how patient safety is valued and acted upon. The article is both a critique and a call to action, urging the health care community to replace indifference with accountability and to treat preventable harm as a moral crisis requiring immediate response.
APA Reference:
Millenson, M. L. (2025). Why we still kill patients. American Journal of Medical Quality, 40(1), 24–25. https://doi.org/10.1097/JMQ.0000000000000213
Podcast Link:https://notebooklm.google.com/notebook/b5ee3d09-5942-49e9-b99a-a3923eb88a0c/audio