NBC News reports on a recent study of the American health care system that has revealed a shocking statistic: Each year, roughly 12 million adults that visit U.S. doctors’ offices and other outpatient settings are misdiagnosed. With about 80 percent of the adult population seeking medical advice every year, this means that one in about every 20 patients is diagnosed with the wrong illness. Possible consequences from this misdiagnosis include serious health problems due to delayed or unnecessary treatment. That means patients with conditions as varied as heart failure, pneumonia, anemia and lung cancer could have serious problems that remain unrecognized by a doctor, according to the study published Wednesday in the journal BMJ Quality and Safety. œWhat we say is, was there a missed opportunity? Was there some kind of a red flag? said Singh, a researcher at the Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, the Michael E. DeBakey VA Medical Center and Baylor College of Medicine. Quantifying such errors has been difficult, largely because researchers don’t all use the same definition for mistakes and it’s hard to track cases across multiple providers over time.
But it’s been a laser focus for Singh, who this week received the prestigious Presidential Early Career Award for Scientists and Engineers from President Barack Obama for his work on missed diagnoses and patient safety.
In the new study, Singh and his colleagues used data from three previous studies that focused on unusual patterns of return visits after primary care visits, lack of follow-up for abnormal findings related to colorectal cancer and consecutive cases of lung cancer. They were based on electronic œtriggers of errors in records at two large health care systems in 2006-2007 and reports of lung cancer at two institutions. Because they were conducted by Singh’s own research teams, the definitions were consistent and allowed for precise analysis and estimates. What they found was that in a little more than 5 percent of cases, the original diagnosis was wrong ” and could have been accurately detected by the information available in the first setting.œIt is surprising ” 5 percent, Singh said. œYet on the other hand, this evidence has been coming together. Previous studies had hinted that the rate of outpatient misdiagnosis might be that high, or even higher. In fact, Dr. Gordon Schiff, a patient safety expert at Brigham and Women’s Hospital in Boston, said that he believes Singh’s work probably underestimates the actual scope of diagnostic errors. œI think it does give us a good a hard number. Previously, we had softer numbers, he said. œBut the numbers probably overlook other error activity. I would say this is a minimum.
The reasons for the high numbers of œmissed opportunities are varied. Experts cite concerns around various items within the healthcare setting, like the structure of outpatient systems, cognitive biases and unclear clinical guidelines. It will take more than one approach to make improvements.
Efforts to make improvements in other areas ” like wrong-side surgeries and hospital acquired infections ” have really taken off, but there is very little reporting on diagnostic error. Others pointed to concerns with the way primary care is structured in the U.S. health care system.
œDoctors just don’t have much time, said Dr. Otis Brawley, chief medical officer for the American Cancer Society. Physicians often have eight to 10 minutes to make clinical decisions, he says, and are therefore forced to make decisions without complete information or with incompletely digested information. For example, colon cancer can easily be missed initially, he said, because patients often show up with symptoms like a stomach ache or diarrhea, which can be associated with other conditions.
For patients, the new analysis should be a reminder that the doctor is not always right, Singh said. Patients can play a key role in their own care by offering doctors a complete list of symptoms and a full health history at the first visit. After the exam, they should be proactive about following up.
œIf you don’t hear from a doctor about the results of a biopsy, call back. Ask, ˜What about that chest X-ray I had? Singh said. œNo news is not good news.
Diagnostic errors accounted for the largest fraction of malpractice claim payouts, amounting to $38.8 billion between 1986 and 2010, according to a study he authored last spring.
œThis is an issue that merits a lot more attention than it has gotten, he said. œIt’s a major public health problem.
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