Diagnostic Errors and Patient Safety Practices

Diagnostic errors typically fall into one of three groups: an incorrect diagnosis, a delayed diagnosis, or the failure to make any kind of diagnosis. Researchers from Johns Hopkins University School of Medicine have found that diagnostic errors make up a significant fraction of all claims. The researchers estimate that there are between 80,000 and 160,000 preventable deaths in the United States each year due to diagnostic errors. Along with the cost in lives, there are financial costs as well; the estimate is $38.8 billion in malpractice payouts between 1986 and 2010.

Diagnostic Errors are Hard to Track

While there has been a significant amount of attention placed on mistakes in surgery and errors in prescribing medication, diagnostic errors have largely been overlooked. One of the reasons is that they are often difficult to track since a significant amount of time can pass between the error and the time that its consequences are discovered.

The Missed Diagnosis

The most common type of diagnostic error is the missed diagnosis. According to the leader of the Johns Hopkins study, this type of error occurs where medical personnel know enough to make the correct diagnosis, but fail to do so. Compared to surgical and medication errors, missed diagnoses tend to be subjective. Adding to this problem is the high cost of testing. Doctors are forced to make a choice between ordering more tests and potentially making a wrong diagnosis.

A missed diagnosis does not always indicate negligence. Even highly skilled physicians providing reasonable care can make mistakes. The key to determining whether the doctor was negligent is to evaluate what steps they took to arrive at their diagnosis. A preliminary examination of the patient should provide a doctor with a list of several possible diagnoses; the list should then be narrowed down with testing. In a best-case scenario, only one diagnosis from the list will remain at the end; however, the list may be lengthened or thrown out altogether as testing progresses.

Sources:
http://www.hopkinsmedicine.org/news/media/releases/diagnostic_errors_more_common_costly_and_harmful_than_treatment_mistakes
http://healthland.time.com/2013/04/24/diagnostic-errors-are-more-common-and-harmful-for-patients/
http://www.ncbi.nlm.nih.gov/books/NBK133399/