Tackling the Problem of Misdiagnosis

If you’ve been attending conferences and reading journals lately, you already know that there’s a lot of buzz about improving diagnosis in health care. In fact, the Institute of Medicine’s (IOM) most recent installment in the Quality Chasm series is “Improving Diagnosis in Health Care.” Although data on misdiagnosis is fairly sparse, the best estimate is that one in 20 (5%) of outpatients is misdiagnosed, and about half of these misdiagnoses is harmful.

Misdiagnosis has significant implications for patient care. Misdiagnosis can delay or prevent necessary treatment, or force patients to endure unnecessary or harmful treatments. Unnecessary treatments cost potentially huge sums of money (to both the patient and the medical system), and take a significant psychological toll. Even worse, diagnostic errors are often fatal. Medical errors, including misdiagnosis, are the third leading cause of death.

What causes diagnostic errors to occur?

First, pressure on doctors to see more patients in less time forces them to make quick decisions which they often do not revisit, increasing both the risk for a misdiagnosis to happen in the first place and the risk for it to go undetected. This is particularly true in settings like the ER where a doctor is seeing numerous patients he or she likely has no history with.

Second, physicians can be overconfident about their abilities and make decisions based on incomplete or incorrect data or understanding. If physicians even know about these mistakes (and often they do not since misdiagnosed patients frequently seek out a different provider), they are loathe to admit them. The problem is compounded by the fact that few organizations have any systems in place to track or provide feedback about diagnostic performance. Physicians aren’t incented on, or even aware of, the number of diagnostic errors occurring, which prevents the physician and the institution from learning from or attempting to improve diagnostic problems

Improving diagnosis in health care

To reduce the number of patients receiving an incorrect diagnosis, the IOM report suggests a practical step for hospital administrators, hospitalists, internal medicine physicians and medical residents: “Education and training across the career trajectory plays an important role in improving the diagnostic process and reducing diagnostic errors and near misses.” Providers need convenient, ongoing education to keep their skills sharp and to introduce emerging trends.

In addition to constantly refreshing what they do know, physicians also need to stay aware of what they don’t. Physicians who understand their knowledge gaps are more likely to ask someone else for help and less likely to make an incorrect diagnosis based on an incomplete understanding. Providing physicians with insight into their own strengths and weaknesses is critically important.

The founder of Knowledge to Practice has first hand experience with misdiagnosis. Her own daughter was misdiagnosed with pulmonary stenosis and had to undergo multiple unnecessary invasive procedures, including a balloon valvectomy at just six months old. As a result, misdiagnosis is very near and dear to our hearts. One of the major goals of our educational products is to help physicians identify their own knowledge gaps and equip them with the information they need. By doing so, we hope to help them make the right decision in every situation, preventing unnecessary treatment, reducing waste, and producing better outcomes.