Poor patient outcomes and high healthcare costs can be caused by misdiagnosis. It is the leading cause of medical malpractice lawsuits, according to a Johns Hopkins study 5. This account accounts for 35.2% and an estimated 80,000-160,000 deaths yearly.
Misdiagnosis can result from a delay or failure to treat an actual disease or misdiagnosing diseases. This would make diagnoses the third leading cause 6 of death in the U.S., after cancer and heart disease. According to a study in BMJ, half the diagnostic errors 7 are caused by adult outpatients.
Telemedicine, COVID-19 Impact
The growth of telemedicine in the past decade could have contributed to an increase in diagnostic error rates. According to McKinsey research, telemedicine usage has increased by 50-175x 8 in the COVID-19 pandemic.
Telemedicine can be a great way to make it easier for patients to get the care they need. What happens if a doctor cannot perform a full physical exam on a patient by phone or via video chat? If a patient only describes her symptoms, will important clues be lost?
The Doctors Company is a prominent malpractice carrier. It reports 9 that diagnosis error is the most common claim 10 against their members. These are the top telemedicine errors:
- Cancer (25%).
- stroke (20%)
- Infection (20%)
- Orthopedic concerns (10%)
Telemedicine-related claims were historically a small part of claims.
McKinsey’s study shows that 76% of consumers would like to use telemedicine in the future, up from 11% of actual usage in 2019. 57% of providers also view telehealth as more favorable than before COVID-19. Telehealth will be a more important component of patient encounters in the future. However, diagnostic error rates could increase if proper precautions are not taken.
COVID-19 is likely to impact diagnostic error rates in some other ways.
- Multiple symptoms can signify the disease, which can complicate diagnosis.
- During outbreak surges, clinical staff can be stretched. This could lead to cognitive fatigue.
- Implementing rapid organizational processes for providers to manage the surge and promote staff safety could lead to clinicians becoming more error-prone.
An Inconvenient Truth
Why don’t we learn more about diagnostic errors if they are so important?
“Diagnostic errors are underappreciated and under-recognized in general because they are difficult to measure and track owing to the frequent gap between when the error occurs and when the error is detected,” Dr. David Newman Toker, who heads the Johns Hopkins study, says.
It is difficult to find accurate data about diagnostic error rates. So no one can be certain. Many have debated the definition of diagnostic errors. However, doctors, I have spoken to agree that diagnostic error is more common than people realize.
Were reluctant to report
Newman-Toker also suggests that experts have minimized the impact of diagnostic errors due to their fear of opening a can of worms that they cannot close. “While there has been progress in dealing with other types of patient harm,” he said, “There is no magic bullet solution to diagnostic errors. They are more complex than other patient safety concerns.”
A culture of mutual support has meant that physicians and other clinicians are hesitant to report the errors of their colleagues.
In fear of being sued for malpractice, they have been reluctant to report errors. Hospitals and other providers are incentivized not to draw attention to errors in diagnosis. You also have to accept that such errors are more common than is generally believed, but the problem lies elsewhere.
What’s a diagnostic error?
A diagnosis error is a failure to correctly identify and communicate the cause of a patient’s health problem promptly. Effective treatment plans, both in terms of patient outcomes and cost, are dependent on timely and accurate diagnosis.
Wrong diagnosis
For example, a patient suffering from a heart attack may be diagnosed with acid indigestion. A post-mortem examination may help to determine the exact diagnosis. Of course, this is not always possible. Data can be reported incorrectly, but it is not always done.
Delay diagnosis
Cancer is the most common. It is usually much more difficult to treat if it is not detected early. Many illnesses can’t be detected until the symptoms persist or get worse.
Missed diagnosis
Sometimes, the cause of a patient’s complaints is not always obvious. Some examples include fatigue, chronic headaches, or loss of appetite.
What is the cause of so many diagnostic errors?
There are many causes of diagnostic errors. Cognitive issues can cause these errors due to the complexity of diagnosis or system issues due to healthcare delivery.
ICD–10–CM diagnosis codes represent nearly 70,000 diseases 12. However, less than 200 presenting signs, 13 make it impossible for any doctor to be fully informed about each disease and its associated symptoms. It is difficult to diagnose the right disease with the help of expert databases and clinical decision support tools. Many refer to this as the “Sherlock Holmes” part of medicine.
It is important to understand why one would ask patients questions, perform certain physical exams, consider different diseases (“differential diagnosis”), and order specific tests from thousands of available tests to evaluate the most dangerous or likely diagnoses accurately. To get the correct treatment, one must interpret these findings accurately.
