The number of people in the U.S. who are permanently disabled or who die each year as a result of misdiagnosis is estimated to be over 100,000.
EurekAlert recently reported findings by a Johns Hopkins research team. The paper was published online in the journal Diagnosis. The team was led by one of Johns Hopkins safety experts who conducted the analysis of a large repository of malpractice claims provided by insurance companies.
The three major categories were infections, cancer, and vascular events, accounting for three-fourths of serious injury due to “medical miscalculations”. The team calls these diseases “the big three”. The most common conditions for each class of disease are blood infection (sepsis), lung cancer, and heart attacks.
Diagnostic errors headed the list of the most catastrophic and costly medical mistakes. The team leader, Dr. David Newman-Toker explained that over ten thousand diseases with their accompanying symptoms have been identified.
A Case of Bias
However, Dr. Newman-Toker cautioned that emphasizing only the most severe cases may cause bias. The reason lawyers typically bring cancer malpractice cases to trial is that it is easier to establish a paper trail. This would move the focus away from long-term chronic illnesses such as migraines or multiple sclerosis. Many of these illnesses have been misdiagnosed for years.
The team addressed these issues by studying “nonclaim” data in clinical settings. These studies turned out to be similar to the malpractice data whereby the big three disease classes were evident. The only difference was that cancer placed third to vascular events and infections.
At first, when they took these huge numbers into consideration, the team could not fathom attempting to solve the problems of misdiagnosis. Then upon closer examination, they realized that the most serious problems occurred in a relatively small number of conditions. Now there seemed to be an easier starting point that generated enthusiasm for a plan to fix the problem.
The Source of the Discovery
Over eleven thousand diagnostic error cases found in the national Comparative Benchmarking System (CBS) database were analyzed from 2006 to 2015. CBS contains data from four hundred hospitals representing over 180,000 physicians in the U.S.
About the Discovery
The evidence was clear that judgment failures in various clinics represented eighty-five percent of cases that were misdiagnosed. About seventy-one percent of these errors happened in ambulatory settings such as outpatient clinics and emergency departments. Half were found to inflict permanent disabilities and half resulted in death.
Approximately thirty percent of children under the age of twenty were misdiagnosed by clinicians who neglected to identify their infections.
The researchers offer the following suggestions:
- Diagnostic support tools (computer-based)
- Expediting access to specialists
- Enhancing effective teamwork
- Enhancing patient engagement during diagnosis
- Establishing feedback for diagnostic performance
- Enhancing diagnostic education by way of simulation training
Preparing for the Next Three Phases
Part II of the three-part study will estimate the frequency of misdiagnosis of fifteen common conditions. The third and final part of the study will utilize national data sets to establish the number of people in the United States who have been harmed each year as a result of diagnostic errors.
Dr. Newman-Toker said that improving diagnosis is a professional and moral public health imperative.
Have you or anyone you know been misdiagnosed?