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.
33190cookie-checkMisdiagnosis