Confronting the iceberg: delayed diagnosis or misdiagnosis
New research has found that more than 1 of every 4 medical malpractice claims involve diagnostic errors. And those claims may only be the tip of the iceberg of a much larger problem.
May 14, 2013
A delayed diagnosis or a misdiagnosis of a condition can lead to serious complications -- including death. For example, delays in diagnosing melanoma after pointing out irregular moles might mean a less favorable outcome. In other cases, a complete misdiagnosis of an illness could prove fatal. This could occur if a family physician sends a child home with a stomach virus diagnosis after failing to ask more questions and catch indications of acute appendicitis.Patients need to be aware of how doctors reach a diagnosis and ask questions. New research has found that more than 1 of every 4 medical malpractice claims involve diagnostic errors. And those claims may only be the tip of the iceberg of a much larger problem.
The researchers from Johns Hopkins analyzed records from the National Practitioner Data Bank, which compiles information on medical malpractice claims and adverse medical actions. They compared various error types, severity of outcomes and payments over a 24-year period from 1986 - 2010. Diagnostic errors were the most common type of error and resulted more often in death than other errors.
Most of the errors were missed diagnoses and more likely to occur in outpatient care. However, fatalities due to a diagnosis error occurred more often during inpatient care.
Some patient safety experts estimate that incorrect, missed or delayed diagnosis happens in 10 to 20 percent of cases. The problem is more common than prescription mistakes or surgical errors, which get more attention and may be easier to address.
Reaching a diagnosis
A doctor must exercise reasonable care in diagnosing a patient. Doctors often use clues from described symptoms, medical tests and their medical training to compile a list of all possible diagnoses that might explain what is wrong with the patient. Then a process of elimination called "differential diagnosis" narrows the list by looking at symptoms or test results that might not fit with a particular diagnosis. In the end, the doctor is left with one diagnosis.
Patients or the family of a patient can ask a doctor to explain what other diagnosis options he or she considered and why they were discarded. Writing down other possible diagnoses may provide information to help discover what is actually wrong if a treatment does not work.
Possible causes of diagnostic errors
Some of the causes of diagnostic errors may relate to flaws in reasoning or biases. A mistake may occur when a doctor sticks with an initial diagnosis even after receiving subsequent information to the contrary. Some errors could relate to decision-making biased by outside information. For example, a drug-addicted patient with abdominal pain may be treated for drug withdrawal when the real problem is a bowel perforation.
Because diagnostic errors are often hard to detect, these errors have received less attention and study than they should. Working with the field of cognitive psychology, researchers are studying how physicians process information and take shortcuts to reach diagnosis. Prevention of diagnostic errors may require more feedback on diagnostic performance and the increasing use of technology.
When indications exist that a missed or delayed diagnosis is to blame for a worsening condition or death of a loved one, contact an experienced medical malpractice attorney. Cases involving diagnostic errors are complicated and require the expertise of a lawyer well versed in the field of medicine.
Article provided by Biancheria & Maliver, P.C.
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