By: Dr. Ken Teufel
Most Americans will experience at least one diagnostic error in their lifetime, according to a report from the Institute of Medicine (September 22, 2015). "Diagnostic errors have been largely unappreciated," says report chair Dr. John Ball of the American College of Physicians. "The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate." Oftentimes, the chain of events required to make a diagnosis creates multiple opportunities for error. The IOM report says that diagnostic errors have never really been studied in detail. No one really knows exactly how many people suffer from misdiagnosis every day. We do know, however, "the problem is significant and serious," says Dr. Ball, and more common than acknowledged by the medical community.
Every year, at least 5 percent of adult outpatients suffer a wrong or delayed diagnosis.
Diagnostic errors are implicated in one of every 10 patient deaths.
Chart reviews reveal that up to 17 percent of adverse outcomes in hospitalized patients are due to diagnostic errors.
Diagnostic errors are the main cause of paid malpractice claims.
"Not all errors are individual errors," says Dr. Ball. "They occur in a system that leads you into certain kinds of behavior." He cites the chaos often found in emergency rooms as an example, where trying to coordinate the care of multiple patients at the same time can be difficult and distracting. Multitasking in this environment does not lend itself to error-free patient care. Another part of the problem is our tremendous reliance on testing, according to Dr. Helen Haskell of the Society to Improve Diagnosis in Medicine. "You have to know to order the right test, and the test has to be interpreted correctly all along the line." We should also take into account the ever-increasing administrative burden being placed on doctors, says Dr. Donald Berwick of the Institute of Healthcare Improvement. "Physicians spend so much time filling out forms, seeking approvals and ordering things -- you can't increase work pressure so much without expecting errors to increase" (USNews.com, September 22, 2015).
The IOM report admits that there's no quick and easy fix to this growing problem. The report concludes that everyone must play a role in preventing diagnostic errors. In the end, patients and their families need to be their own best advocate, not afraid to ask the right questions: What else could it be? When will you let me know the test results? Would a second opinion be helpful?
About the author: Dr. Ken Teufel is the medical director at Interim Physicians, a pioneer locum tenens physician staffing firm based in St. Louis, MO that has provided quality physician coverage to hospitals, clinics and other healthcare facilities since 1979.