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New Study Indicates Severity of Misdiagnoses in Medicine

A recent study found that misdiagnoses are the most common type of medical malpractice, leading to 800,000 serious injuries or deaths each year. Diagnostic errors, including failing to diagnose a disease, diagnosing an incorrect disease or a delayed diagnosis of a disease, are a dangerous and often deadly mistake happening across healthcare settings.

Thousands of Americans Are Misdiagnosed Annually

A study by researchers at Johns Hopkins and Harvard Medical School that was recently published in the BMJ Quality and Safety Journal investigated the annual number of serious harms (permanent serious injuries or deaths) that are caused by misdiagnoses.  The study concluded that an estimated 795,000 Americans become permanently disabled or die each year because dangerous diseases are misdiagnosed. Of those serious injuries, an estimated 371,000 people die and 424,000 are permanently disabled after a misdiagnosis.  The true number of misdiagnoses each year is likely much higher, as many diagnostic errors go undetected and most do not result in serious harm.  Most misdiagnoses do not lead to serious injuries because they occur in the course of treatment for a minor illness or non life-threatening ailment.  However, for those people who see a doctor with serious, life-threatening conditions, risk of death associated with misdiagnosis is 4%, and the risk of severe disability is 11%.

Why Do Diagnostic Errors Occur?

There are several different reasons for misdiagnoses.  A major cause of misdiagnosis is atypical presentation – the patient presents with symptoms that are not typical or are common to other, less severe conditions.  Sometimes a doctor may overlook symptoms of a disease in a patient population that is not particularly susceptible to that disease.  Systemic bias also increases the risk of misdiagnosis, for instance being a woman or person of color increases the risk of being misdiagnosed by 20-30%.

The study found that just 15 different diseases and events from the “Big Three” categories of vascular events, infections and cancers account for more than half (50.7%) of the total serious harms caused by diagnostic errors.  The top five categories of misdiagnoses (stroke, sepsis, pneumonia, venous thromboembolism and lung cancer) accounted for 38.7% of the serious injuries.

The Importance of Reducing the Frequency of Diagnostic Errors

This study’s conclusions are important to the effort to reduce and eliminate diagnostic errors.  For healthcare providers, finding ways to avoid errors in these most commonly misdiagnosed diseases could save many lives.  For instance, requiring doctors to consult with a second physician before discharging a patient in all potential stroke cases could reduce the number of misdiagnosed strokes. Healthcare providers should try to eliminate the number of diagnostic errors not only to improve patient safety (which should be their first priority) but also to control healthcare costs.  While a second opinion policy could increase the costs of healthcare, it would be a minor increase as compared to the cost of a misdiagnosis.  If patients are diagnosed correctly and in a timely fashion, the costs of treatment will be significantly less than the cost of treatment of a preventable catastrophic injury.

The Johns Hopkins study confirms that diagnostic mistakes are occurring at an alarming rate across health care settings and that certain patients are at higher risk.  Hopefully, the information gathered will be used to influence policies and practices, to protect patients, and to improve patient outcomes.