Let’s not sugarcoat it: diagnostic errors are the leading cause of malpractice claims and preventable adverse events among healthcare providers.
Possibly more disturbing is the risk of harm or injury to patients could reach levels of moderate to severe in at least 85% of the 190 cases studied in a recent Jama Internal Medicine study. Furthermore, 36 patients of these patients had serious complications and 27 may have died.
“Diagnostic errors are associated with substantial harm at the individual patient and public health levels, and their burden may be much greater than previously appreciated,” said David E. Newman-Toker, MD, PhD, from the Johns Hopkins University School of Medicine in Baltimore, Maryland.
Let’s take a look at the three most common causes for diagnostic errors and possible ways to avoid them.
Patient Medical History
The inadequate capture of a patient’s medical history and failure to review his or her previous documentation during the patient encounter were to blame for more than 78% of errors.
Sadly, the transfer of a patient’s medical records between PCPs is still a flawed system. Many times doctors don’t have adequate information to properly diagnose and treat patients.
Physicians need to have a patient’s complete chart and medical history available during the clinician-patient encounter to avoid misdiagnosis. Furthermore, the study highlighted several of the most common types of conditions affected by diagnostic errors, including pneumonia (6.7%), congestive heart failure (5.7%), kidney failure (5.3%), cancer (5.3%) and UTIs (4.8%).
Doctor/Patient Communication
Diagnostic mistakes are almost guaranteed to happen at any practice. But according to the same study, breakdowns in the clinician-patient encounter are at the root of many errors – the second leading cause of misdiagnosis, actually.
Many times patients don’t express their symptoms correctly to physicians, which, in turn, can lead to a misdiagnosis.
It’s important to be thorough and ask the right questions during the initial patient encounter. As you already know, most of the time patients don’t have a clue when it comes to their health.
Cognitive Errors
Sometimes, aches and pains or sniffles and coughs are just symptoms of a cold that will likely go away with minor treatment. That doesn’t mean you should ignore a pestering sore throat or lingering heartburn, which can signal a more serious condition that requires urgent care.
In practice, the most common cognitive error for doctors is the premature closure of the diagnostic process, in which the physician may not even consider the correct diagnosis as a possibility.
Many times doctors assign common benign diagnoses to patients with uncommon serious diseases – a possibly fatal error.
Following their errors, many physicians in the study said that, in the future, they would broaden their differential diagnosis and consider specific “don’t-miss” diagnoses for specific presenting complaints.
But such errors are likely to remain a problem as long as providers are pressured to keep visits short and make decisions on the run. The authors of the study express hope that new models of healthcare delivery and the growing focus on patient engagement and shared decision-making could provide safeguards.
“The greater use of EHRs to determine the cause of errors could advance knowledge about conditions that are vulnerable to being missed in primary [care] and help prioritize diagnostic errors in primary care settings,” concluded the study’s authors.
