Diagnostic Errors Common, Costly, and Harmful

John Commins, for HealthLeaders Media , April 23, 2013

Because we don't see the harm very often, both because they are infrequent as a fraction of all the diagnostic errors we make and because the ones who die don't come back to see us when we systematically missed those events we have this kind of collective delusion that we are usually right.

HLM: What can hospitals or physicians do to improve on these misdiagnoses?
N-T: Although there are a number of solutions that have been proposed, none of them are magic bullets. They range from simple check lists all the way to highbrow, computer-based diagnostic decision support. Those solutions are probably going to have to be used in concert in very dedicated ways to solve particular types of diagnostic error problems.

None of those solutions, all interventions described out there to reduce diagnostic errors, have ever been properly tested at the highest level of did 'I actually save anybody?' They have been proposed and described and tested on paper cases but never actually studied in practice. My view is there are a lot of potential solutions out there. But in order for those solutions to be properly tested we need to measure this on an ongoing daily regular basis.

HLM: Why aren't more hospitals or physicians taking it upon themselves to address this issue?
N-T: There is right now no incentive to track diagnostic errors. In fact there is a disincentive. If no one is required to report it why would a hospital want to look under the rug and find all these dust bunnies; that their diagnostic error rate is 10% to 15 % of all their encounters?

That would look bad. There would be mass panic and confusion, particularly if they are the only ones saying it. That is the problem. Everyone is afraid to look at this issue and as long as no one forces them to look at it they are going to keep it under the rug as long as they can.

John Commins is a senior editor with HealthLeaders Media.

Comments are moderated. Please be patient.

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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