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Misdiagnosis behind a third of malpractice cases

by Thomas Dworetzky, Contributing Reporter | July 16, 2019
Misdiagnosis is the most common, most costly and most dangerous medical error — accounting for 34 percent of all malpractice cases, according to a recent Johns Hopkins study in the journal Diagnosis.

“It is not just inconvenient to have a wrong or delayed diagnosis. For many patients, misdiagnosis causes severe harm and expense, and in the worst cases, death,” lead author Dr. David Newman-Toker, professor of neurology at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality’s Center for Diagnostic Excellence, said in a statement about the study.

Johns Hopkins researchers looked at over 55,000 malpractice claims and found that 74.1 percent of misdiagnoses causing the greatest harm come from cancer (37.8 percent), vascular events (22.8 percent), and infection (13.5 percent).

“If we’re going to reduce serious harms from medical errors, major strides must be made to improve diagnostic accuracy and timeliness,” he stressed, add that “tackling diagnosis in these three specific disease areas could have a major impact on reducing misdiagnosis-related harms.”

The onus of the problem does not rest “solely on the shoulders of individual physicians,” noted the researchers.

“We know that diagnostic errors happen across all areas of medicine. There are over 10 thousand diseases, each of which can manifest with a variety of symptoms, so it can be daunting to think about how to even begin tackling diagnostic problems,” advised Newman-Toker, “Our findings suggest that the most serious harms can be attributed to a surprisingly small number of conditions. It still won't be an easy or quick fix, but that gives us both a place to start and real hope that the problem is fixable.”

The researchers described, in a Johns Hopkins statement on the study, 15 specific conditions that together account for nearly half of all the serious, misdiagnosis-related harms. The top conditions in each category included stroke, sepsis and lung cancer, respectively. These are accompanied by heart attack, venous thromboembolism, aortic aneurysm and dissection, arterial thromboembolism, meningitis and encephalitis, spinal infection, pneumonia, endocarditis, and breast, colorectal, prostate and skin cancers.

This work underscores that diagnostic delays and failures are multifactorial — and “highlights the need for further collaboration across the healthcare system to significantly improve diagnosis and ensure the best possible outcomes for patients,” said Paul L. Epner, chief executive officer and co-founder of the Society to Improve Diagnosis in Medicine, which funded the Johns Hopkins study. “The complexity of the diagnostic process and the collaborative approaches needed to improve accuracy mean change will not occur overnight.”

The work adds background to a 2015 National Academy of Medicine report that found such diagnostic errors cause nearly 80,000 deaths a year in U.S. hospitals.

One way to help matters, advised the society, is its ACT for Better Diagnosis initiative, through which, as part of a coalition, more than 50 national organizations “representing health systems, patients and families, clinicians, risk managers, testing professionals, and others” have committed to initiatives to improve diagnostic quality and safety.

When the coalition was announced in January, Epner stated that, “for too long, improving diagnostic quality and safety has not been on the radar of health organizations,” and noted, “but that is changing, and it’s exciting to now see that a groundswell is building and taking hold across all sectors of health care. These healthcare leaders are recognizing that improving the diagnostic process saves lives, reduces harm, and will save costs to the system.”

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