Outpatient Misdiagnosis Information

Although there have been few studies about patient misdiagnosis, a new study published in the BMJ Quality & Safety shows that 5.08 percent of adults are incorrectly diagnosed annually, which translates to about 12 million adults in the US. More than 6 million patients face serious risks due to misdiagnosis a year in the US alone. The situation also leads to wasted medical resources.

However, proper investigation of outpatient misdiagnosis has been challenging because the complex process involves several providers in different settings. It is important to get the perspectives of physicians for a better understanding of delayed, missed and incorrect diagnoses.

According to a report published by the National Institutes of Health, one study involving internists showed that processes tended to break down in the testing phase while another study involving primary care physicians revealed that medical errors resulted from poor processes of care of test results.

Unfortunately, many physicians do not know about their misdiagnoses and have no way to determine the patients who were misdiagnosed. Nevertheless, the doctors can easily report the challenges they face in the diagnostic processes.

Researchers surveyed 1,817 physicians and received responses from 1,054–80 percent of whom primarily practiced in outpatient settings. The respondents had practiced for an average of 13 years, with 32 percent reporting to have worked in private practice before.

The cognitive factor that was most commonly reported was inadequate knowledge base, with more seasoned physicians reporting relatively less diagnostic difficulty. More diagnostic difficulty arose from problems associated with the referral process and information processing. The strategies most frequently used for improvement concerned workload issues, such as reducing the sizes of physicians’ panels and increasing patient visit times. The respondents also reported that diagnostic delays would be reduced by better access to specialists.

However, the referral process was seen as hindering complete and timely diagnosis even where sub-specialists were readily available. The PCPs reported difficulties communicating with the sub-specialists.

In addition, two factors related to the patients consistently appeared in the responses: failure to provide details about symptoms, and non-adherence to diagnostic evaluation and physician recommendations.

The study showed that diagnostic safety concerns could be reduced by addressing practice-level issues like the time for processing diagnostic information.

Resources:
http://qualitysafety.bmj.com/content/early/2014/04/04/bmjqs-2013-002627.abstract?sid=840d8fdf-c20d-486e-a29b-8b742ef910f3
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680371/