Posted by Bill Sandweg on 08 May 2014.
The Robert Wood Johnson Foundation is the largest philanthropy in the United States dedicated to the improvement of public health. As part of its mission, it recently published a report on the prevalence of diagnostic errors, which it contrasted with the lack of interest in the subject by policymakers. Citing widespread research, the authors state that diagnostic errors are the leading cause of malpractice claims which result in payment and are nearly twice as common as the next most common error. They occur across all medical fields and most often involve common diseases.
The authors attribute the failure to address the problem of diagnostic errors to a number of causes, including the difficulty in measuring them. As in many areas of today’s life in the United States, that which can be measured gets attention; that which cannot be measured well is often given short shrift.
There are many reasons for diagnostic errors and the report does a good job of discussing them. The reasons primarily fall into the category of cognitive biases and system errors. Some well-known cognitive biases are availability (frequent or recent medical problems come most easily to mind), anchoring (locking onto a particular symptom too early in the diagnostic process leading to failure to adequately consider other symptoms), confirmation bias (looking for confirming evidence to support a diagnosis instead of looking for evidence which contradicts the diagnosis), and diagnosis momentum (what started as a possibility is repeated as the patient is handed off and quickly becomes a certainty). System errors are those which are inherent in the medical system such as poorly standardized procedures, poor communication, poor handoffs, excessive workloads, and inadequate follow up.
The authors present a number of what they refer to as “preliminary suggestions” for policies to put diagnostic errors on the public policy agenda. They include enhanced research to identify the extent of the problem and to measure it, enhanced conditions of participation in Medicare, quality improvement and collaboration, follow up and feedback, and fundamental malpractice reform. On the malpractice front, they recommend changing over to a non-adversarial system which will improve patient compensation for diagnostic errors while at the same time enhancing cooperation and open discussion about them. All in all a very interesting paper which is worth your time.