Posted by Bill Sandweg on 17 June 2019.
Some recent reports show that misdiagnosis is a leading cause of medical malpractice. This is not news to me or to anyone who represents patients and families injured by malpractice. Diagnosis is hard. Diseases and illnesses don’t always present with the same signs and symptoms every time. A good diagnosis takes work and patience.
One medical malpractice insurance company reviewed 1,800 closed claim files involving the doctors it insured to see what was the cause of the claims against the doctors. It found that 46% of the claims involved misdiagnosis. In 45% of those cases, the patient died. Another insurer reported on claims involving the treatment of children and reported that 38% of the claims against its doctors arose out of misdiagnosis. Still another study concluded that the third leading cause of death in hospitalized patients resulted from misdiagnosis.
It is easy to understand how these figures come to be. Diagnosis is one of the most difficult tasks a health care provider faces. It usually involves a series of steps be taken to get to the correct result. If any one of the steps is done incorrectly, the result may be a mistake in diagnosis. To top it all off, sometimes the steps must be taken quickly and in emergency circumstances.
The first thing that must be done is to get some basic information. This is called the “history” and it is an area with great potential for a mistake. The provider usually asks the patient what is the problem. Depending on the patient’s answer, the provider may go on to ask directed questions to elicit more information.
There may be a language barrier interfering with this question and answer process and, even if there isn’t, misunderstandings in communication are a common, everyday problem. The patient may not understand what are the most important symptoms to tell the provider. The provider may get misled by what the patient thinks is her primary complaint. The patient may not remember to tell the provider about an earlier doctor visit or test result or diagnosis. The provider may be in a hurry and not spend the time she should talking with the patient. The provider may be impatient and this may cause the patient to hold back for fear of angering the provider. The provider may not ask the appropriate follow-up questions. In short, lots can go wrong at this stage.
Even if the history taken by the provider is complete and both provider and patient did a good job, there is still lots of opportunity for a misdiagnosis. One of the sayings often repeated by medical malpractice defense lawyers at trial is, “When you hear hoofbeats, you think horses, not zebras.” They say this when they are defending a doctor accused of failing to diagnose an illness or problem which is unusual. They say this because providers will sometimes jump to conclusions about what the problem is without going through all the appropriate steps. They get something in their heads and they fail to consider other possibilities. Doctors are supposed to create what is called a “differential diagnosis,” which is a mental list containing all of the possible explanations for the patient’s condition. They should then “rule out” the more serious of these possibilities until they get down to a shorter list of explanations and then order testing to reduce the list further.
Diagnosis is not an easy thing. You can do your part by being sure to tell the provider about all of your health issues, your medications, your past doctor visits, hospitalizations and diagnoses.
My best advice to you is not to catch anything too rare. If you do, the chances the doctor will think horses instead of zebras goes way up.