The Wall Street Journal:
Mistakes diagnosing patients are the most common, costly and dangerous errors made by doctors in the
U.S. and result in permanent injury or death for as many as 160,000 patients
annually, a new study found. Surprising and disturbing findings in a new
study from Johns Hopkins University reveal how often doctors are mis-diagnosing
patients and at what cost. Laura Landro and lead author of the study David
Newman-Toker join Lunch Break to discuss. Researchers at Johns Hopkins
University looked at more than 350,000 malpractice claims over 25 years.
They found that diagnostic errors—defined as missed, wrong, or delayed
diagnosis—accounted for nearly 29% of claims, more than other categories
such as treatment, surgery or medication. Diagnostic errors made up the
biggest share of claim payments at 35.2% of total payments, or $38.8 billion,
adjusted for inflation, from 1986 to 2010. They resulted in death in more
than 40% of claims.
Top five patient problems that doctors failed to diagnose correctly in
a 2013 study of errors in primary-care visits:
- Worsening congestive heart failure
- Acute renal failure
- Urinary tract or kidney infection
Some leading reasons for errors:
- Breakdown in communication during patient's initial visit to doctor
- Doctor fails to refer patient to a specialist
- Patient doesn't provide adequate medical history
- Doctor fails to follow up with patient after diagnosis
- Diagnostic tests aren't interpreted correctly
Source: JAMA Internal Medicine; Houston VA/Baylor College of Medicine
More than a third of pest-management companies in the U.S. were called
in by hospitals in 2012 to exterminate bedbugs, according to a new survey
by the National Pest Management Association. MarketWatch's Jim Jelter
reports. (Photo: AP)
The study, published online Monday in the journal BMJ Quality and Safety,
underscores the trade-offs in the diagnostic process: More medical tests
generally improve detection, but they can also increase costs, harm patients,
and produce false positives. Fear of a malpractice suit for missing a
diagnosis is a major driver behind "defensive medicine," the
"There isn't going to be one magic bullet to solve the problem
of diagnostic error, but we can start by consistently monitoring and measuring
it," says David Newman-Toker, lead author of the study and an associate
professor of neurology at Hopkins.
While hospitals report on quality measures such as cardiac bypass surgery
outcomes, diagnostic errors aren't reported or measured by federal
or private quality programs. "No one wants to tell anyone they are
missing 10% to 20% of their diagnoses," Dr. Newman-Toker says.
Hardeep Singh, a researcher at Michael E. DeBakey VA Medical Center, Houston,
Texas and assistant professor of medicine at Baylor College of Medicine
who has wrote several studies on diagnostic error, says that while the
Hopkins study confirms previous research, malpractice data provide a limited
picture. Often, a diagnosis "evolves over time" so a patient's
problem might not be clear from initial symptoms, Dr Singh says, but that
isn't necessarily a diagnostic error.
Dr. Singh and other researchers are studying how to better define and measure
errors and what strategies best prevent them, such as using electronic
health records to track patient test results and helping doctors with
software that suggests an alternative diagnosis based on symptoms.
The Johns Hopkins researchers acknowledged that claims data are imperfect:
Some claims paid may not be associated with true error, and the vast majority
of true errors never result in a claim. But prior studies show that paid
claims are mostly not frivolous and malpractice data can be an indicator
of the prevalence and seriousness of adverse events. The study compared
closed paid claims from the National Practitioner Data Bank, which was
established by federal law in 1986 and keeps an electronic repository
of all malpractice payments.
Researchers found roughly equal numbers of lethal and nonlethal mistakes.
Previous estimates of hospital deaths from diagnostic error were as high
as 80,000 per year, which suggests that total diagnostic errors could
be twice that level, and "it is probably a lot higher than that,"
Dr. Newman-Toker says.
The study found that the highest payments were for severe, permanent neurological
damage. While the data didn't show the cause of the damage, Dr. Newman-Toker
estimates there are 100,000 missed strokes annually in the U.S. "There
is probably a huge amount of unmeasured disability due to diagnostic error"
with strokes, he says.