Study Reveals Errors in Diagnosis Account for Biggest Payouts in Medical Malpractice Suits

This is a guest post by Jennifer Buchanan.

If you are keen to avoid a malpractice suit and are interested to know which area of practice you are most at risk from, the findings of a study published in the April edition of the journal BMJ Quality and Safety, might well be of interest. The research, which assessed over 350,000 claims during the 25 years from 1986, indicated that it is errors relating to diagnosis and not those with regards to surgery or medication that account for the largest proportion of medical malpractice payouts.

This study highlighted that 35% of the $38.8billion paid over this time period was as a result of delayed, missed or wrong diagnoses. However, missed diagnoses were the most common and errors in diagnosis occurred more frequently in outpatients than inpatients. Diagnostic errors were also found to be those most likely to result in death or long-term disability and based on this data, as many as 160,000 errors resulting in this may occur in the US each year. Those leading to neurological damage necessitating life-long care were found to lead to the largest compensation awarded. Previous studies have indicated that as a general rule, errors in diagnosis occur at a rate of 10 to 15% and it is more serious illnesses that tend to be misdiagnosed, which may be as high as a quarter in these cases.

Most common misdiagnoses

These most recent findings added to work reported by researchers at Johns Hopkins University at the end of 2012, which indicated that a quarter of patients admitted to the ICU die as a result of misdiagnosis; based on this, close to 40,500 deaths may occur as a result across America each year. Five clinical conditions were found to account for a third of all problems missed in the ICU. After heart attack, pulmonary embolism and pneumonia are most likely to be missed, followed by aspergillosis and abdominal bleeding; with so many affecting the circulatory and respiratory system, it is understandable why there are so many fatalities. Receiving so much information about each patient and working in such a hectic environment, any ICU staff appreciate how easy it could be to come to the wrong conclusion about a diagnosis for a patient; the same could be said about the emergency department, another hotspot for misdiagnosis. Looking at other medical departments, while cancer isn’t the most commonly misdiagnosed condition, the implications for an error are potentially huge, which is why so many medical malpractice suits are made with respect to this. When all malpractice claims are considered, breast cancer, lung cancer and colon cancer are within the top five conditions for claims relating to diagnostic errors.

Contributing factors

Considering what contributes to errors in diagnosis, a study of malpractice claims from primary care in 2006 revealed that in more than 50% of cases the appropriate tests had not been ordered. However, in over 40% of cases errors in history taking and physical examination had occurred and in excess of 40% there had been a mistake made when formulating of a follow-up plan. These findings could be applicable to many fields of medicine and this work demonstrates that rarely is there a single attributable cause and indeed in many of these cases there had been another doctor involved.

Extensive experience and strong skills in diagnostics can reduce the risk of failing to diagnose conditions correctly, but even this does not make doctors immune to such errors and being on the receiving end of a medical malpractice suit. To avoid misdiagnosis it is therefore suggested that:

For each patient you see, devise a clear list of their medical problems, including long-term and acute conditions, symptoms that can’t be accounted for, what medications are taken and any allergies; this is not just for your own benefit, but ensures consistency should other doctors be involved.

Bear in mind that a new symptom may or may not be related to an existing condition; don’t forget to consider the bigger picture, as any symptom could offer a clue to something else.

Make use of decision support systems when available to help with differential diagnosis.

Have criteria for when tests should be ordered or specialist referrals made and apply these every time it is necessary.

Keep at the front of your mind those symptoms that warrant urgent attention.

Ensure that where you work there is a system in place to alert you to any changes that occur in imaging and lab reports when compared to those taken at baseline.

Review your original diagnosis with the presentation of new signs and symptoms.

Symptoms mentioned by a patient as they are ready to leave should still be given the same care as if it had been mentioned earlier in the consult; it is a mistake to consider it is of lesser importance and make a snap decision with regards to diagnosis, so request they make another appointment to discuss further.

Patient responsibility

While you carry a large responsibility for ensuring medical conditions are diagnosed and treated correctly, patients keen to file a lawsuit when they are subject to an error in diagnosis, should consider what part they may have played in this themselves. As any doctor knows, a patient failing to mention symptoms, not following prescribed therapy or failing to attend appointments to discuss progress can all contribute to a disease being missed, incorrectly diagnosed or delay diagnosis. Equally, the eagerness of patients to know what is causing their symptoms can rush doctors into making a diagnosis before they have sufficient evidence to do so. This important process can never be rushed and patients need to realize this. Discussing your initial findings, plan of action and reassessment lets them know where they are, but that over time presentation can change, as can test results, so it may become apparent that an initial diagnosis was incorrect.