Misdiagnosis: National movement afoot to address diagnostic errors

A misdiagnosis can be devastating.

In the case of Thomas Eric Duncan, the first Ebola patient in the United States, it led to his death. He was initially diagnosed with sinusitis by an emergency room doctor. By the time he returned to the hospital two days later, he was gravely ill and infected two nurses with the virus. 

Unfortunately, diagnostic errors are not rare cases. The statistics are alarming. Last year a study in BMJ Quality & Safety revealed that doctors make 12 million outpatient diagnostic errors each year--roughly one in every 20 diagnosis. But the rate may be even higher, according to the head of a new coalition formed to address dignostic errors. He places the rate at roughly 10 percent of all diagnostic encounters.

I recently spoke to Paul Epner, pictured right, chairman of the newly formed Coalition to Improve Diagnosis and the executive vice president of the physician-led non-profit that established it, The Society to Improve Diagnosis in Medicine, to learn more about the group's plans to reduce the rate of diagnostic errors. 

The coalition is made up of leaders from healthcare organizations and medical societies, including the American College of Emergency Physicians, the American Association of Nurse Practitioners, the National Patient Safety Foundation and The Leapfrog Group.

They met for the first time this week and plan to tackle soon-to-be-released findings from the Institute of Medicine, which has spent two years researching the topic. The report is a follow-up to its groundbreaking reports, To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century.

Epner said that all members agree that diagnostic errors have not received enough attention. Part of the problem is that there are so many reasons for a misdiagnosis, including clinical reasoning, problems interpreting tests, imaging issues, communication errors and symptoms that could indicate several conditions or that come and go, he said.

"These errors occur every day and they go from benign consequences to death. In most cases it's not even something discussed in hospitals. So it's difficult to measure. If you miss a diagnosis, how do you know you missed it until someone comes up with it? You only know after the fact," Epner said.

In some instances a physician may never know if a patient seeks a second opinion at a different hospital or with another physician.

"We believe every hospital should have this on their agenda of patient safety concerns and economic concerns. If you start out with a wrong diagnosis and the treatment is wrong, a waste of dollars and potentially a worsening of the original condition," he said.

Every hospital must come up with an approach to measure diagnostic errors and take appropriate actions to resolve the identified problems, he said.

Educational interventions, increased collaboration between laboratories and clinicians, improved patient handoffs are just some of the steps hospitals can take to reduce the chance of a diagnostic error.

Epner says his organization is taking several approaches to address the problem. It is working with a board of certified physicians to develop a curricular approach for new and existing physicians and is also collaborating with patients to develop consumer tools to reduce errors.

"The big message is that it involves the physician from training through retirement, every actor in the healthcare system from payers to risk managers to clinicians, laboratorians, radiologists and patients," he said. "This is a significant opportunity to engage lots of players on a very understudied subject that is such a significant problem."

 

 

 

 

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