Diagnostic Errors Common, Costly, and Harmful

John Commins, for HealthLeaders Media , April 23, 2013

Newman-Toker spoke with HealthLeaders Media about his findings. The following is an edited transcript of the interview.

HLM: Were the results you got the results you expected?
N-T: We were anticipating most of the results. There were certain aspects of this that we expected, but there wasn't prior literature. For instance: The high frequency with which claims were associated with disability and not just death. That has not been previously looked at and that is one of the most important findings from the data we analyzed.
It really indicates that the magnitude of the problem as has been previously assessed through autopsy studies is a significant underestimate of the serious negative impact and harm associated with diagnostic error.

HLM: What seems to be the pitfall here?
N-T: There are no quality measures that systematically ask the question 'What is our accuracy of diagnoses?' 'How often do we make diagnostic errors?' 'What is the impact of those diagnostic errors?' The call to action message from this paper and many others that we have tried to publish over the last five to 10 years to shed light on this problem is that we must systematically measure diagnostic errors. It must be a requirement and it must be part of the quality reporting guidelines in order for us to start tackling this problem."

HLM: What is the source of this diagnostic disconnect?
N-T: I don't think it is arrogance, although some of it is overconfidence in the sense that we have a system that does not give us a great deal of feedback on the accuracy of our diagnosis. Not every patient gets the same follow-up. The patients who come back to see us come back because they are satisfied and they like us and they send us Christmas cards and knit us shawls and we think of ourselves as good diagnosticians as a result.

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2 comments on "Diagnostic Errors Common, Costly, and Harmful"

Marcia C (11/30/2013 at 3:55 PM)
11.30.13 Kaiser failed to treat me for a deadly infection Klebsiella Pneumoniae for 3.5 months despite my pleas of urgency, frequency and pain. I had to demand a referral to a urologist and another lab test with culture. Docs thought I had female "overactive bladder syndrome" and referred me to pelvic floor physical therapy and Kaiser gave me a discount on "glide and silk creams" and I was told to lie on two little balls and relax my psoas muscles. One error after another resulted in recently 10 days of hospitalization for sepsis, kidney issue and a pulmonary embolus from PICC line. I almost died. Terrible experience

WrongDiagnosis (4/23/2013 at 5:14 PM)
I had a wrong diagnosis at Kaiser and had to get the correct diagnosis out of system, and then fight Kaiser to have them treat me. I later spoke with a doctor working on the EHR system at Kaiser. They don't have a diagnosis area in it, so doctors have to read through the previous doctors' notes without any sort of summary of what has been ruled out. I would suggest for serious cases there is a diagnosis "tab" in the EHR. This is the model of our country's EHR system; and thousands will be harmed by it. This is a serious issue in medicine and must be addressed. I lost a year of my life, I guess I'm lucky I didn't die.




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