When you get sick, you need a diagnosis. If the diagnosis is wrong, the treatment won’t be appropriate. What happens when doctors make diagnostic errors? We talk with a leader in the Society to Improve Diagnosis in Medicine about his recent research.
Clinicians make an estimated 12 million diagnostic errors every year, although the number might be even higher. As many as half a million to a million of these misdiagnoses result in serious patient harm. Dr. David Newman-Toker and his colleagues examined a database of settled malpractice claims to determine which conditions account for the preponderance of serious harms due to misdiagnosis. They found that the vast majority could be classified under one of three rubrics: cancer, cardiovascular events and infections.
Frequently, clinicians who have made diagnostic mistakes never hear about them. With an estimated 12 million misdiagnoses each year, however, we could count these errors among the leading causes of death in the US. Such blunders are rarely if ever listed on the death certificate as a cause of death. Would it help if they were? Should there be an Institute for Diagnostic Error Prevention among the National Institutes of Health?
Systems errors that interfere with tests being done or the results reported in a timely fashion can contribute to diagnostic problems. However, many of the errors in diagnosis involve problems with clinical judgment–the way doctors approach the problem and the questions they ask, as well as the way they factor in the answers. One simple thing the patient can do is ask: “What is the worst thing this could be?” The appropriate follow-up question is: “Why do you think it is NOT that?” Patients should expect a serious answer based on their (accurately described) symptoms or lab work. A dismissive “I’m the doctor” answer is not adequate.
Close collaboration between physicians and patients gives everyone the best chance of avoiding diagnostic mistakes. If the doctor does not have a reasonable response, seek a second opinion.
Dr. Newman-Toker recommends that patients take the following steps to minimize the chance of being misdiagnosed.
You will find these questions and many more in our book, Top Screwups Doctors Make and How to Avoid Them.
David Newman-Toker, MD, PhD, is Director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence and Director of the Division of Neuro-Visual & Vestibular Disorders in the Department of Neurology. He is also Professor of Neurology at Johns Hopkins University School of Medicine.
His article, "Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers" was published in Diagnosis. The photo is courtesy of Johns Hopkins Medicine.