A new report commissioned by the U.S. government contends that most Americans will encounter at least one diagnostic error in their lifetime, sometimes with severe consequences for their physical and mental health.
The report, released Tuesday by an independent panel at the Institute of Medicine (IOM), urges changes to an increasingly complex health care system that may be adding to the problem.
“This latest report is a serious wake-up call that we still have a long way to go,” Victor Dzau, president of the National Academy of Medicine, which oversees the IOM, said in an IOM news release.
“Diagnostic errors are a significant contributor to patient harm that has received far too little attention until now,” he said.
The new IOM report is the latest in a series that have examined the ongoing issue of medical errors. Focusing this time on missed or mistaken diagnoses, the panel noted that diagnosis has always been “a collaborative and inherently inexact process.”
“Diagnosis is a collective effort that often involves a team of health care professionals — from primary care physicians, to nurses, to pathologists and radiologists,” said Dr. John Ball, chairman of the IOM committee behind the report and executive vice president emeritus of the American College of Physicians.
“The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate,” Ball said in the IOM news release.
A misleading diagnosis can be costly in terms of trauma to the patient and their loved ones, missed opportunities for treatment, unnecessary treatments and other issues, the report said.
Litigation costs stemming from faulty diagnoses can also be huge. According to a study of 350,000 U.S. malpractice cases published in 2013 in the journal BMJ Quality & Safety, lawsuits involving missed or wrong diagnoses were the leading cause of payouts between 1986 and 2010.
Researchers led by Dr. David Newman-Toker, of Johns Hopkins University School of Medicine in Baltimore, estimated that the number of misdiagnosis-related claims that cause preventable, permanent damage or death may be as high as 160,000 each year.
The new IOM report stressed that there are many players involved in diagnosing a sick patient, and more must be done to help coordinate care. These partners include:
- Patients and their families. The IOM panel urges that health care organizations offer more help to patients and their loved ones in terms of understanding a diagnosis, and widen access to electronic health records, including clinical notes and test results. Patients and families should also be made to feel comfortable about offering their own opinions and feedback, the IOM said.
- Health care organizations. These key players need to learn from past mistakes and use that knowledge to improve systems so diagnostic errors decrease. A more “open” corporate culture, where people aren’t punished for pointing out errors, is key to this, the IOM panel said.
- The legal system. States should work with entities in the health care sector to “promote a legal environment that facilitates the timely identification, disclosure, and learning from diagnostic errors,” the IOM said.
- Health care professionals. Doctors and other staff may need training that focuses on “clinical reasoning, teamwork, communication, and diagnostic testing,” the panel said.
All of this must be a coordinated, team effort involving patients, health care workers and organizations, Ball stressed.
“To make the changes necessary to reduce diagnostic errors in our health care system, we have to look more broadly at improving the entire process of how a diagnosis is made,” he said.
An expert in patient safety agreed.
Jennifer Lenoci-Edwards is a registered nurse and director of the Institute for Healthcare Improvement. She said she wasn’t surprised by the prediction that most Americans will eventually encounter at least one diagnostic error.
“Health care continues to get more complex,” Lenoci-Edwards said. She said her group “agrees with the stated goals [of the IOM report], especially those that relate to increasing the role of team-based care in making diagnoses and engaging the patient in these conversations.”
Her advice to patients? Don’t be silent.
“When you have that nagging feeling that you have not gotten your questions answered by your physician or provider, stop and raise it again,” Lenoci-Edwards said. “Trust your intuition that you know your body best,” she advised.
“In addition, patients and family members should be sure that they understand the purpose of a test, and how and when the results will be communicated,” she added.
There’s more on how you can help avoid a medical error at the U.S. Agency for Healthcare Research and Quality.