Misdiagnosis

In a new study in the BMJ Quality & Safety, researchers analyzed diagnosis-related claims from a national data bank from 1986 to 2010 and found that diagnostic errors accounted for about 35 percent of the total payments of $38.8 billion (after adjusting for inflation).   This means that making the wrong diagnosis is the most common reason for malpractice lawsuits.  In other words, doctors should NOT play god but they better not be human and make a mistake on their diagnosis.  A MSN piece gave their little spin with quotes from some Ivory Tower geniuses.   Amazingly enough, some were actually good!  Here are some examples with my thoughts in parenthesis:

  • “These are the most common and the most costly of all malpractice claims,” said study author Dr. David Newman-Toker, an associate professor of neurology at the Johns Hopkins University School of Medicine, in Baltimore. “We have to pay attention to this because it is too big of a problem to ignore.” (Pay attention to what?  how does one know they are making a wrong diagnosis?  And if they did, wouldn’t they change it?)
  • Sometimes, these mistakes can be fatal right off of the bat. “If someone has a headache, and you say ‘take two aspirin and call me in the morning,’ but the headache is really a brain aneurysm, the patient could die before morning,” Newman-Toker added. (We have algorithms and standards of care for this.  All headaches shouldn’t be scanned.  Docs should never be liable if they followed evidence-based medicine in these scenarios)
  • Patients are not powerless. “Even great doctors make mistakes,” he said. “Ask, ‘is there anything else this can be?'” he advised. “If the doctor says ‘no’ [then] ask ‘why?’ and an answer such as ‘because it’s the only thing it could be’ is not good enough.” (Good point but not every diagnosis can be argued just because you didn’t get what you want. i.e. narcs, antibiotics, MRI, etc.)
  • Dr. David Troxel, medical director of The Doctors Company, a malpractice insurer based in Napa, Calif., said the study “provides valuable information to caregivers about medical errors.  I believe that the disclosure of this information will enhance patient safety. Patients can also play an important role in reducing the incidence of diagnostic errors by providing their doctor with an accurate medical history, adhering to the prescribed follow-up plan, keeping return visit appointments to discuss abnormal test results and asking questions to clarify instructions they don’t clearly understand.” (Patient responsibility, huh?  What a concept!)
  • Malpractice attorney Michael Sacopulos, CEO for the Medical Risk Institute in Terre Haute, Ind., said he was surprised by the extent of the new findings. “Maybe things get off course right at the beginning, but this has not been studied as much as other errors that result in malpractice suits,” he said.
  • Still “medicine is an art and not a science so this will happen,” Sacopulos said. “Patients need to be persistent with physicians because so often the doctor will make a diagnosis and over time, it becomes clear that it was wrong. The first attempt may not be accurate. Think of it as a work in progress instead of being written in stone.” (I am speechless)
 Yes, doctors make mistakes.    Good follow-up is the key and that is why family medicine, in my opinion, has less lawsuits than other professions.   We have good relationships with our patients and they know they can call or come back if they think they need their situation revisited. Now that I work in an urgent care I can see how having one shot at making a diagnosis is so risky.  You are on a high wire without a net.   That being said, I am blown away that the malpractice attorney makes the most sense.  Medicine is an art he says!   Amen.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “Misdiagnosis

  1. Michelle
    April 24, 2013 at 12:03 pm

    EMR requires a diagnosis on admission, which is often too early to make a definitive diagnosis. I have bed. Told by billing, just write the most likely diagnosis, we cannot bill a “rule out”. Any surprise some of theses diagnoses are incorrect?

  2. Ken
    April 23, 2013 at 6:12 pm

    Even algorithims and standards of care are far from flawless since they often rely on the patient’s history, which is subjective and often inaccurate. Many patients with benign headaches complain of the “worst headache ever” and often given a history of a sudden onset. Scan ’em all? Many (most?) serious illness can present with very vague sxs intially, and I dare say most physicians have a story or two (or three) to tell regarding their experiences with these.

  3. Pat
    April 23, 2013 at 8:25 am

    Don’t be taken in by this bastard malpractice attorney. OF COURSE he will strike a reasonable, even concilliatory tone. Knowing how much he and his drive defensive medicine costs, he wants to be the good guy in PR terms, but none of this even-handedness will show up in the courtroom transcript. How noble of him to admit medicine to be an art…that it should be admits to inherent error, which is this guy’s gravy train. What he didn’t say of his “art” is that when suit is filed, the plaintiff attorney has 100% of the facts, which by definition, the initially diagnosing physician never has.

    Its fine for a member of this despicable breed to to recognize a “work in progress” in public, but that language will not be part of the plaintiff’s complaint in the event of a poor outcome.

    • Douglas Krell MD
      April 23, 2013 at 10:11 am

      Amen brother.

    • Doug Farrago
      April 23, 2013 at 10:41 am

      good points

      • DrBonz
        April 24, 2013 at 10:37 pm

        Doug, AGAIN you find it necessary to attack specialists. You know as well as I do that Family Practitioners get less malpractice cases filed against them simply because they operate at a lower risk. Specialist who perform procedures are obviously more likely to get sued. The FP can simply pass the buck onto their specialists if ever there is any question. I, on the other hand can’t do that. I must be held responsible for a complicated case that a FP referred to me while he is now held harmless (for the most part) since he referred the case out. And for the record, you aren’t the only doc out there who has a good relationship with his patients. We specialists (at least this one) do just fine. Was the little dig at us really needed in this argument?

        • Doug Farrago
          April 25, 2013 at 12:22 am

          I am not sure where I was digging specialists on this? I am pointing out the RARE advantage we FPs have.

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