A recent report from the Institute of Medicine (part of the National Academies of Science, Engineering and Medicine) highlights the seriousness of missed or delayed diagnosis. It described how most people will have at least one such event in their lifetime, and that “diagnostic errors [are] a blind spot in modern medicine that sometimes causes devastating consequences.”
The report concludes that diagnostic errors have not received enough attention or plans for improvement. It cites the example of the Liberian man with Ebola who was initially misdiagnosed in two ER visits. Most diagnostic errors do not receive such attention, but the consequences for individual health or treatment can be just as devastating. One problem is that there is no way to know how often this occurs, since it is not part of standard medical reporting. Studies in particular institutions, however, give a clue to how serious the problem is. By one estimate, 1 in 20 adults who seek outpatient treatment each year experiences a diagnostic error.
Medical negligence attorneys know that this is a major problem, because diagnosis errors are a major reason for malpractice claims, and are almost twice as likely as other claims to result in a patient’s death. Some medical conditions have received significant attention, such as patients presenting to an ER with chest pain. Algorithms, specific lab tests, and protocols have decreased the number of heart attacks or impending cardiac deaths that might otherwise occur. Other steps recommended by studies are better teamwork among providers, better communication, and making the patients or their families part of the decision-making process.
The Institute of Medicine also recommended patient actions that might help reduce the incidence of diagnostic mistakes, such as asking questions of providers (what else could it be?), clarity in describing symptoms, conveying family histories, and bringing an up-to-date list of medications. These all seem to be common sense steps, but it still remains the physician’s duty to take into account all of the information she has in order to reach the correct diagnosis. One physician I worked with many years ago said that the most important, but often most ignored, job of a physician is to listen to the patient. In today’s modern medicine, with its emphasis on technology, that part of the job isn’t emphasized enough. There is a book titled “Every Patient Has a Story,” that tells about how eliciting key information from a patient is the key to diagnosing what is wrong with the patient.
