Stemming the Tide of Misdiagnosis in Doctors’ Offices

We know a lot more than we used to about diagnosis mistakes in hospitals, but a new study says that every year, at least 1 in 20 adults gets the wrong diagnosis in a doctor’s office.

For more than 6 million U.S. patients a year, according to the authors of the study published in the journal BMJ Quality & Safety, these misdiagnoses can have major consequences and can amount to medical malpractice.

“The question is, can we eliminate human error, and the answer is no,” Hardeep Singh, lead author of the paper, told The Boston Globe. “We have just now begun to understand what [these errors] are and what we can do.”

Although hospital misdiagnoses aren’t news, said one Globe source, not many researchers have studied the incidence and consequences of outpatient misdiagnoses. We wrote about one such study published last year in JAMA Internal Medicine that showed essentially the same results as the new one in BMJ.

An outpatient error can be as minor as calling a cold an allergy, but it can be as major as overlooking cancer or stroke and causing a dangerous delay in treatment.

Lots of things complicate making a diagnosis, and making sure it’s correct. Doctors must find the right balance between overtesting and overtreating, and missing diagnoses that should have been given more attention and intervention.

And there isn’t even a clear, best-practice definition of diagnostic error. Different practitioners use different measures to define a mistake.

The BMJ researchers analyzed data from three earlier studies, two concerning cancer and one about diagnostic errors recorded in primary care electronic health records. They all used similar definitions of outpatient misdiagnosis.

Because misdiagnosis is complicated, it requires a multifaceted solution, the authors say. It requires the patient, the care team and the health-care system to work together to reduce mistakes. We’ve long been champions of this quality-control approach to delivering health care.

Another Globe source said patients must be involved, and assertive, and readers of this blog know we agree. Patients must tell their doctor about medications they take and problems they’re having. They must ask questions if they don’t understand something the doctor says, or if the doctor isn’t responding to them. Never leave a doctor’s office wondering what happened, what to do and what are the consequences if you don’t understand or follow instructions.

Patients should make sure all their caretakers – people they’re seeing for second opinions, specialists, physical therapists, etc. – have access to their medical data.

Doctors who aren’t completely confident in their diagnosis or treatment recommendation should ask colleagues for a second opinion. That’s often difficult for people in their position of authority, but it’s essential to prevent patient harm. And patients have the right, if not the obligation, to ask their doctor how confident they are of the diagnosis, on a scale of 1 to 10. If the confidence factor is less than 7 or 8, ask for a second opinion.

Expert analysts of the new study said systemic changes also are necessary to lower the rate of outpatient misdiagnosis. Physician support and follow-up should be standard operating procedure.

And when mistakes happen – and they will, no matter how good the care is – practitioners need to know. That’s the only way they can learn from them. According to one Globe source, “There’s a lot of learning that should be going on, that’s not.”

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