Every year in the United States, mistakes in diagnosis cause an estimated 40,000 to 80,000 wrongful deaths in hospitals, according to researchers. Almost a third of all adverse events reported involve diagnostic errors — diagnoses that are delayed, incorrect or missed entirely. Approximately 5 percent of the time, autopsies find clinically significant medical conditions that were missed, where treatment could have resulted in the patient’s survival. In fact, around 40 percent of all medical malpractice lawsuits involve a negligent misdiagnosis.

In the first part of this two-part series, we discussed some of the mental shortcuts doctors take that can lead to diagnostic errors.

However, cognitive errors by physicians are not the primary cause of missed, mistaken or delayed diagnosis. An analysis by the Archives of Internal Medicine indicates that nearly two-thirds involve system-related problems that make it more difficult for doctors to reach an accurate diagnosis.

Researchers: Two-Thirds of Avoidable Diagnostic Errors Caused by Breakdowns in the System

System problems such as delayed or misreported tests, malfunctioning equipment, lack of teamwork, poor supervision and hospital negligence account for nearly two-thirds of diagnostic errors. Examples include:

• Insufficient protocols to ensure appropriate follow-up
• Unnecessary delays in scheduling appointments or procedures
• Requests for consultations are lost or delayed, or specialists are not available in a timely fashion
• Medical equipment is faulty, miscalibrated or unavailable
• Tests or x-rays are not communicated or read in time or are misplaced

Many experts hope that health information technology can help reduce internal communication problems that lead to diagnostic errors. Many say that an anonymous error-reporting system could be a way to give doctors desperately needed feedback from their peers.

While that research continues, many experts say the best way to avoid mistakes in diagnoses is to focus on clear communication with patients. Doctors should openly discuss their uncertainties about a particular diagnosis with the patient and ask them to report any contradictory symptoms.

Like so many others, “this problem is going to require a partnership with the patient,” concludes Dr. Gordon Schiff, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital in Boston.

Source: American Medical News, “Diagnostic errors: Why they happen,” Kevin B. O’Reilly, December 13, 2010