Wall Street Journal: The Battle Against Misdiagnosis
The Battle Against Misdiagnosis
American doctors make the wrong call more than 12 million times a year.
There are times when a single, unexpected death sparks a change in medical practice. In 2012 a 12-year-old boy named Rory Staunton died after being misdiagnosed in a New York City emergency room. Multiple physicians missed the symptoms, signs and lab results pointing to a streptococcal bacterial infection that led to septic shock and overwhelmed Rory’s body. The tragedy prompted New York state in January 2013 to introduce “Rory’s regulations,” a set of stringent protocols aimed at preventing similar incidents in hospitals.
Comparable initiatives to prevent misdiagnosis have not happened on a national level—but there might be reason to expect change soon.
New research my colleagues and I published in April in the journal BMJ Quality and Safety shows the extent of the problem. Based on previous studies of patients seeking outpatient care, we extrapolated data on diagnostic error to the entire U.S. adult population. Each year an estimated 5% are misdiagnosed based on currently available evidence.
This may sound like a decent track record—95% accuracy—given that doctors are grappling with more than 10,000 diseases in patients who present a staggering array of symptoms. But a 5% error rate means that more than 12 million adults are misdiagnosed every year, and our study may understate the magnitude.
Still, after years of taking a back seat to problems such as medication and treatment errors, misdiagnosis is getting attention. In 2011 my research colleague in projects on misdiagnosis Mark Graber founded the nonprofit Society to Improve Diagnosis in Medicine, which now holds an annual medical conference on diagnostic error. More recently, the Institute of Medicine, an influential branch of the National Academy of Sciences that advises Congress on health care, is preparing a comprehensive action plan and hosting its second major expert meeting on Thursday and Friday. In 2015 the IOM will issue a report on misdiagnosis.
Meantime, the U.S. health-care community can take steps to reduce the problem.
The first is to improve communication between physicians and patients. Patients tend to be the best source of information for making a diagnosis, but often essential doctor-patient interactions such as history and examination are rushed, leading to poor decisions. As new forms of diagnostic and information technologies are implemented, managing large amounts of data will become increasingly complex, and physicians could become more vulnerable to misdiagnosis.
This problem exists in large part because time pressures and paperwork often force physicians to spend more time struggling to get reimbursed than talking with patients. Extra hours spent pursuing a correct diagnosis are not compensated beyond the payment for the visit, an already small sum for primary-care physicians.
Patients can’t solve this problem, but insurers can streamline administrative paperwork and re-examine the logic behind reimbursement policies. Hospital systems can help by providing high-tech decision support tools and encouraging physicians to collaborate on tough cases and learn from missed opportunities.
Metrics also need work. As the old business adage goes, you can’t manage what you don’t measure. Yet most health-care organizations aren’t tracking misdiagnosis beyond malpractice claims. Doctors need mechanisms to provide and receive timely feedback on the quality and accuracy of our diagnoses, including better patient follow-up and test-result tracking systems.
Electronic health records will help eventually, but slow innovation in this area has frustrated many physicians. And most doctors still lack access to electronic patient data gathered by other physicians. Doctors can make a more informed diagnosis when they can see the disease progression or learn what other doctors have discovered about the patient.
Finally, patients must start keeping good records of each meeting with a doctor, bringing the information to subsequent medical appointments and following up with the physician if their condition doesn’t improve. No news from the doctor is not necessarily good news.
There is much we don’t understand about the burden, causes and prevention of misdiagnosis. The IOM report will spur progress, but health-care providers, patients, hospitals and payers can all help. The health outcomes of at least 12 million Americans each year depend on it.
Dr. Singh is chief of Health Policy, Quality and Informatics at the Michael E. DeBakey VA Medical Center, and an associate professor at Baylor College of Medicine.