Most Americans who go to the doctor will get a diagnosis that is wrong or late at least once in their lives, sometimes with terrible consequences, according to a report released Tuesday by an independent panel of medical experts.
This critical type of health-care error is far more common than medication mistakes or surgery on the wrong patient or body part. But until now, diagnostic errors have been a relatively understudied and unmeasured area of patient safety. Much of patient safety is focused on errors in hospitals, not mistakes in diagnoses that take place in doctors’ offices, surgical centers and other outpatient facilities.
The new report by the Institute of Medicine, the health arm of the National Academy of Sciences, outlines a system-wide problem. The report’s authors say they don’t know how many diagnostic errors take place. Some estimates say it affects at least 12 million adults each year.
“Despite the pervasiveness of diagnostic error and the risk for patient harm, they have been largely unappreciated within the quality safety movement in health care, and this cannot and must not continue,” said Victor Dzau, institute president.
What’s more, errors likely will worsen because of the growing complexity of the diagnostic process and the delivery of health care, according to the committee that conducted the study. The study is the institute’s third in a series on patient safety. Its landmark 1999 report “To Err is Human” dramatically exposed the number of deaths — as many as 100,000 a year in hospitals — because of errors in medical treatment.
But that report and a subsequent one barely mentioned errors in the diagnostic process.
Part of the problem, experts say, has been the difficulty of measuring such mistakes.
Experts say diagnosis is one of the most difficult and complex tasks in health care because it involves patients, clinicians, thousands of lab tests and more than 10,000 potential diagnoses.
Diagnostic errors result from a variety of causes, the committee found. They include inadequate collaboration among clinicians, patients and their families; limited feedback to clinicians about the accuracy of their diagnoses; and a health-care culture that discourages transparency and disclosure of errors.
The report said health-care organizations need to put systems in place to identify diagnostic errors and near misses. They also need to adopt a non-punitive culture so open discussion and feedback can take place. That could be empowering for frontline workers like medical assistants to act as a check and balance, looking for gaps and raising flags, even if it’s “something doctors won’t like but will appreciate when they avoid a near miss,” she said.
Christine Cassel, president of the National Quality Forum and one of the committee authors, said that means doctors need to change the way they think about finding out from another physician that their patient turned out to have X and not Y.
“Now it would be considered embarrassing and challenging the person’s professionalism to do that,” Cassel said.
Getting it right
Use the checklist during health appointments:
• Be clear, complete and accurate when you tell your clinician about your illness. When did symptoms begin? What made them better or worse? Jot down notes and bring them with you.
• Remember what treatmentsyou’ve tried in the past, if they helped, and what, if any, side effects you had.
• Keep your own records of test results, referrals and hospital admissions. Keep an accurate list of your medications. Bring the list when you see your clinician or pharmacist.
• Remember to ask your clinician these three questions:
1. What could be causing my problem?
2. What else could it be?
3. When will I get my test results and what should I do to follow up?
