Danger: Medical Misdiagnosis Happens In Up To 40% Of All Adults!

Dangerous Medical Misdiagnosis Happens To 5-40% Of All Adult Patients

At least 1 in 20 US adults receiving outpatient care, or 12 million patients annually, are victims of medical misdiagnosis, and half of these medical misdiagnosis errors could be harmful and even fatal.medical-misdiagnosis-image

The authors hope this study prompts systematic changes in order to reduce these medical misdiagnosis errors.

Hardeep Singh, MD, MPH, from the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, and coauthors published their results online April 17 in BMJ Quality and Safety.

“Combining estimates from the three studies yields a rate of outpatient diagnostic errors of 5.08%, or approximately 12 million US adults every year. Based on our previous work, we estimated that about one-half of errors would have the potential to lead to severe harm,” Dr. Singh and coauthors write.

The authors note that the contribution of the cancer medical misdiagnosis to the overall estimate was small, but potent, because delayed cancer diagnoses are thought to be the “most harmful and costly types of diagnostic error in the outpatient setting,” and can have a ripple effect on such issues as malpractice claims.

“[W]e estimate the frequency of diagnostic error to be at least 5% in US outpatient adults, a number that entails a substantial patient safety risk,” the authors conclude. “This population-based estimate should provide a foundation for policymakers, healthcare organisations and researchers to strengthen efforts to measure and reduce diagnostic errors.”

In other studies the numbers are even higher for medical misdiagnosis errors:

15-40% Medical Misdiagnoses:

An estimated 15% of medical diagnoses are in error, with autopsy results showing diagnostic error rates in select areas up to 40%… According to an article in The New England Journal of Medicine:“125 million (Americans live) with chronic illness, disability, or functional limitation….“The typical Medicare beneficiary saw two primary care physicians and five specialists (a) year…“Patients with several chronic conditions may visit up to 16 physicians in a year.”

A special Supplement in The American Journal of Medicine addressed this issue with a comprehensive review of the medical literature:

According to the authors of this review:

“Being confident even when in error is an inherent human trait, and physicians are no exception. When directly questioned, many clinicians find it inconceivable that their own error rate could be as high as the literature demonstrates…

“This reflects both overconfidence and complacency(emphasis added).”

An article on this report makes this dismal observation:

“Medical practitioners really do not use systems designed to aid their diagnostic decision making…physicians have under-utilized decision-support systems and misdiagnosis rates remain high.

Say It Ain’t So, Doc

Many patients don’t want to believe their doctors are capable of such high rates of medical misdiagnoses. These are very intelligent, well-educated people, after all – generally more so than the patients they treat. How can such smart people make so many diagnostic errors?

The obvious answer lay in our fee-for-service payment system that penalizes doctors for spending the time required for thoughtful assessments and diagnoses. These “cognitive” services are reimbursed at far lower levels than procedures – whether needed or not.

Medicare and other payers are partly to blame for perpetuating this skewed payment system, as are those in the medical profession who choose to maximize their incomes at their patients’ expense.

No one’s forcing them to submit to these skewed incentives, after all. Some, like myself don’t, so it’s not impossible.

But there’s more to our excess medical errors than that. Dr. Jerome Groopman helps us understand how doctors’ training perpetuates mental shortcuts and crutches that contribute greatly to medical errors – and to diagnostic errors specifically. Here’s an excerpt from Dr. Jerome Groopman New York Times best selling book, How Doctors Think:

“Misdiagnosis is different (from medical errors)…experts studying misguided care have concluded the majority of errors are due to flaws in physician thinking, not technical mistakes…

“In one study of misdiagnoses…some 80% could be accounted for by a cascade of cognitive errors…ignoring information that contradicted a fixed notion….

“As many as 15% of all diagnoses are inaccurate…

“Physicians tend to go with their first impression…

“The cognitive mistakes that account for most misdiagnoses…largely reside below the level of conscious thinking.”

Doctors, he explains, tend to get stuck on first impressions, something he calls “anchoring” because it anchors or fixates their diagnosis and often that of other doctors to whom you might be referred.

Or they just might not like certain patients, leading them to cut them off from fully describing their symptoms and settle for the most convenient or available treatment.

If they think the patient is a complainer or hypochondriac, they may assume a benign condition and minimize the likelihood of serious disease.

Now these cognitive flaws, as Dr. Groopman describes them, are all understandable as human failings – and Groopman quite understands them having labored with them himself – but are they professional?

Don’t patients have a right to expect more of their highly-paid doctors?

Why should patients have to worry about whether their doctor likes them or not and fear, quite correctly it seems, that it will bias their treatment?

This isn’t high school, after all.

Defensive Medicine is A Failed Response 

The medical profession has failed to address this crisis in patient safety with the urgency it deserves – opting instead for defensive medicine practices intended to insulate them from malpractice liability rather than address medical errors head-on.

This defensive mindset prevents the profession from engaging more meaningfully to correct both diagnostic and treatment failures.

And with more patients seeking medical care as Obamacare is implemented, doctors will have even less time to spend with patients. The risk of diagnostic errors – and medical errors generally – is likely to increase as a result.

A thorough diagnostic work-up takes time and thought – both of which are in increasingly short supply in America’s broken healthcare system.

All of which means patients will have to learn how to protect themselves and their loved ones when engaging with our fundamentally flawed medical system.