Posted by Bill Sandweg on 02 September 2019.
A recent article in the peer-reviewed medical journal Diagnosis concluded, “[D]iagnostic errors remain the most common, most catastrophic, and most costly of serious medical errors . . . .”
The researchers were from Johns Hopkins University School of Medicine and from CRICO Strategies, an insurance program affiliated with the Harvard medical institutions. They dug into closed insurance files representing a large portion of all malpractice claims in the United States over a recent ten year period. They found that nearly three-fourths of serious misdiagnosis-related harms occurred in just three major categories – vascular events, infections and cancers. They concluded one-third of all malpractice claims that result in death or permanent disability were the result of a misdiagnosis or a delayed diagnosis. There are over 10,000 known or recognized diseases but only a few symptoms or signs lead the way to each one. There are often overlaps in the signs and symptoms. Given the complexity of the problem, it is perhaps understandable that mistakes are made.
Another conclusion the researchers drew from the malpractice data was that over 84% of misdiagnosis claims were the result of clinical judgment failures. They believe this means there is room for significant improvement in reducing misdiagnosis injuries by improving diagnostic decision making for only a relatively small number of high-risk conditions in just a few clinical settings.
The researchers found that most of the diagnostic process failures occurred during bedside assessments and in clinical reasoning arising from knowledge gaps on the part of the physician.
When a patient develops a cancer and it begins to produce symptoms, more often than not, the patient seeks treatment at an outpatient, ambulatory facility. The patient may return on a number of occasions over time. Because of the nature of these outpatient visits and the fact that the patient may see a number of different providers on these visits, they create an increased risk of missed communications and discontinuous care that lead to a missed or delayed diagnosis.
We patients have a role to play in improving diagnostic accuracy and avoiding some of the causes of a missed or delayed diagnosis. The Society to Improve Diagnosis in Medicine (SIDM) recommends that patients ask the following questions of their health care providers:
- What is my diagnosis? What else could it be?
- Why do you think this is my diagnosis? From test results? From my physical exam?
- Can you give me written information about my diagnosis? A pamphlet? A website?
- Can you explain the test or treatment you want me to have?
- What are the risks to the test or treatment you want me to have? What happens if I do nothing?
- When do I need to follow up with you?
- What should I do if my symptoms worsen or change, or if I don’t respond to treatment.
They also recommend that you always ask when your test results will be ready and call if you do not receive them. Do not assume that no news is good news, always call. Ask for your records and keep copies of your test results. Play your part to avoid being the victim of a misdiagnosis.