Misdiagnosis major issue, better care teamwork urged

Most people will experience at least one wrong or delayed diagnosis at some point in their lives, a blind spot in modern medicine that can have devastating consequences, says a new report that calls for urgent changes across health care. Studies of patient medical records also suggest that 6 percent to 17 percent of “adverse events”, or harms that occur to patients during a hospital stay, resulted from diagnostic errors.

Doctors now are not encouraged or paid to communicate as much as they should be, Ball told NBC News, explaining that radiologists and pathologists should be more involved in diagnosis because “there are 30,000 diagnostic tests – 10,000 of those are molecular tests”. Other times, patients recover anyway and may never know there was an error.

The blame, researchers said, is most squarely placed on collaboration and communication between members of medicals teams treating patients, patients themselves, and their families. Some estimates say it affects at least 12 million adults each year.

“Finally, by studying treatment errors, we can learn more of the system problems that lead to diagnostic error…”

“It’s probably one of the, if not the, most under-recognized issues in patient safety”, said Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins. Improving diagnosis is a complex challenge, partly because making a diagnosis is a collaborative and inherently inexact process that may unfold over time and across different health care settings.

Part of the problem, experts say, has been the difficulty of measuring such mistakes.

Even among the IOM committee’s medical specialists, “many of us had experienced what we would define as a diagnostic error”, Ball said.

“The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate”, Ball said in the IOM news release.

That technology is similar to the computer support that pilots get in the cockpit, “engineering tools to help the doctor think things through in real time”, said Dr. Art Papier of VisualDx, one widely used system that matches symptoms to a visual library of possible diagnoses.

However, the report from the National Academy of Medicine, formerly the Institute of Medicine, asserts that for all the progress made in improving healthcare quality, the essential step in the chain-assessing and diagnosing what is wrong with the patient-has received less than adequate attention. The advocacy group petitioned the IOM to produce the report. That would include educational approaches that update clinicians about new evidence-based guidelines, certification and accreditation programs that test competency and processes across healthcare professionals’ career trajectory.

In the IOM committee, doctors mentioned the case of a woman who was criticized for questioning her doctor after being diagnosed with acid reflux when she truly had a heart attack. After three major procedures, she can now breathe fairly well. And that, she said, will encourage others to follow suit. More doctors’ offices and health systems now have electronic health records, but clinicians often complain the systems are hard to use. Creating an environment for patients to question a diagnosis or add information about their condition could also help better inform diagnoses. Often the scenario involves a physician missing something and a patient, who doesn’t get better, seeking a second opinion.

Dr. Christine Cassel, president of the National Quality Forum, said the only way health providers can really learn from their mistakes is by telling them the mistake they made. That could be empowering for frontline workers like medical assistants to act as a check and balance, looking for gaps and raising flags, even if it’s “something doctors won’t like but will appreciate when they avoid a near miss”, she said.

To address such problems, the committee called for greater communication between doctors, patients and their caregivers.

“Now it would be considered embarrassing and challenging the person’s professionalism to do that, ” she said.