A medical diagnosis serves as the foundation for all the care that comes afterward. But when that diagnosis is incorrect, it can have disastrous consequences for both the patient and the healthcare provider.
Diagnostic errors in medicine are more common than you might think, and they often happen as a result of systemic or procedural issues in medical settings. Here's why these errors happen and what you can do to prevent them in your practice.
We wrote an entire blog covering the top 5 medical errors, read it here!
A diagnostic error occurs when a medical provider fails to establish an accurate and timely explanation for a patient's health problem. Diagnostic errors also happen when providers fail to communicate these explanations to the patient, leaving them unable to make informed decisions about their own healthcare and any next steps, if needed.
These errors tend to fall into one of four distinct categories:
Errors in the diagnostic process happen very frequently. In fact, it's estimated that at least 12 million diagnostic errors happen in the United States each year. These errors are also responsible for the death or serious injury of 40,000 to 80,000 patients annually.
In hospital settings, diagnostic errors cause 6 to 17 percent of all adverse events. While a failure to diagnose can happen in any medical setting, they're actually most common in ambulatory clinical settings. This is because providers in these settings are often operating under time constraints and aren't able to monitor the patient's symptoms for long enough.
Roughly 75% of misdiagnoses fall into three categories, which experts refer to as the "Big Three": vascular events, infections, and cancers. Diagnosis errors are also common in neural diseases.
Here are a few examples of what these errors look like in practice:
There are many reasons why errors happen when making medical diagnoses. While sometimes these errors happen as a result of a lapse in judgement, they're more often a result of systemic issues within the healthcare system.
Types of diagnostic errors include the following:
Many missed and delayed diagnoses aren't even conscious decisions. Instead, they happen as a result of the unconscious biases that affect a healthcare professional's judgement. Fatigue, distraction, and workload can all distort clinical decision making during diagnosis.
Here are just a few of the cognitive biases that affect diagnostic performance:
Because these cognitive biases can happen to anyone, providers must be aware of them and take steps to mitigate them throughout the clinical reasoning process, especially when diagnostic difficulty or atypical presentations make it easier to narrow possibilities too quickly. Maintaining a broad differential diagnosis is a key part of that process.
Many busy healthcare professionals have jam-packed schedules, which means appointment times are relatively short. When this happens, providers might rush through the patient's medical history and initial assessment. Rushing can cause providers to overlook important information that could affect the diagnosis.
Issues with clinical laboratory tests can also lead to inaccurate or delayed diagnoses. For example, the lab might use an incorrect test for the patient's symptoms, or send back incorrect data. This could lead to an inaccurate diagnosis that could cause the patient harm.
Many labs also struggle with testing delays, which can interfere with the diagnostic process. Assume a patient is suspected of having a bacterial infection, but the provider needs to run a test to confirm it. If that test isn't done in a timely manner, the patient's infection could progress without appropriate treatment and become dangerous.
46% of healthcare professionals in the United States report feeling burned out, and that physician burnout can lead to medical errors. When providers are tired or overwhelmed, they might miss important diagnoses that they would usually catch.
Poor communication is a huge cause of diagnostic errors in medicine, and it can happen in a number of ways.
This starts with poor communication between the patient and the medical professional. If the patient doesn't feel comfortable or doesn't know how to accurately describe their symptoms, it can be difficult for a provider to make a more accurate diagnosis. Language barriers also present significant challenges to physicians and patients alike.
A lack of communication between providers can also lead to errors. For example, if a nurse performs a patient intake exam, but doesn't clearly communicate their findings to the doctor making the final diagnosis, the results may be inaccurate.
Errors can also happen when providers fail to collaborate or refer patients to specialists. In many situations, a second opinion and specialist expertise is necessary for the best patient outcomes.
To make accurate diagnoses, medical providers must stay up-to-date with the latest research and best practices in their specialty. Education on diagnostic reasoning should extend across the healthcare professions, not just physicians.
If healthcare organizations don't invest in continuing education, providers could end up making diagnoses based on outdated information. Structured bias-reduction training should start in medical school and continue for family medicine residents. Training methods can also include simulation with standardized patients to strengthen diagnostic skills.
Many of today's healthcare organizations use an electronic health record (EHR) for patient information. While EHRs are more efficient than traditional paper records, providers can still make mistakes when using them.
Assume a patient's primary care doctor fails to add important information about a patient's pre-existing condition to their EHR. A few years later, the patient sees a specialist for a different medical condition. The specialist does not have all the information about the patient's pre-existing condition, which leads them to make an inaccurate diagnosis. This is why strong health information technology design and workflow integration can also reduce documentation and follow-up mistakes.
Electronic systems can also help identify patients who need follow-up on abnormal findings.
We authored blogs on the topics of charting by exception and charting with a jury in mind, read them today!
The Swiss cheese model is a way to visualize medical errors as a result of systemic failures. It's rare for a wrong diagnosis to have just one cause. Instead, these errors usually happen when multiple safeguards fail.
The Swiss cheese model visualizes each safeguard as a slice of Swiss cheese. When the 'holes' in the cheese line up, errors can happen. To address diagnostic errors, healthcare organizations need to consider all contributing factors, not just the initial mistake.
Diagnostic errors can have serious consequences for both patients and providers. Here's what can happen when patients do not get the diagnoses they need.
When a patient is incorrectly diagnosed, they can't begin treatment. This can have a significant negative impact on patient safety and health.
Without treatment, the symptoms of their illness or injury are likely to progress. This can cause pain and discomfort that interferes with everyday life. In severe cases, a lack of treatment can even lead to premature death.
An inaccurate diagnosis could also result in patients receiving inappropriate treatment for their symptoms. For example, they may take a prescription medication they don't need, which leads to harmful side effects. Diagnostic errors could even lead to unnecessary surgeries and other invasive procedures.
In both scenarios, patients could experience significant financial losses from excess medical bills. If their symptoms or side effects are severe enough, they may also not be able to work.
On top of that, patients who experience diagnostic adverse events may lose trust in the medical system. These patients may hesitate to seek treatment in the future, which could lead to poor health outcomes.
There are also serious consequences for healthcare providers and organizations that make diagnostic errors. Most notably, these errors can lead to medical malpractice claims. Research on US malpractice claims from 1999 to 2016 found that 22% were related to diagnosis errors, accounting for a total of $5.7 billion in paid claims or settlements. Sources such as the National Practitioner Data Bank are also used to analyze diagnostic-error claim trends across the healthcare industry.
Medical malpractice claims can be incredibly costly for providers, which is why reliable malpractice insurance is so important. If you're accused of malpractice, you could be held liable for extensive damages or settlements, plus you'll be responsible for defense costs. A good insurance policy covers these expenses so you can focus on defending yourself and your practice.
If you're held liable in a malpractice case as a result of a diagnostic error, it could significantly damage your reputation and make it difficult to attract patients in the future. In severe cases, diagnostic errors could also lead to disciplinary action from medical regulatory boards, with broader financial and reputational effects across the healthcare industry.
Preventing diagnostic errors and other patient safety events starts with better systems. Try implementing these strategies to stop diagnostic errors before they happen.
A simple but effective strategy for reducing diagnostic error is to require providers to take diagnostic timeouts. This means that the provider waits for a set period of time before finalizing the diagnosis. This pause gives them time to evaluate any cognitive biases that may be affecting the diagnosis, and to review any laboratory and pharmacy data for accuracy.
Another helpful strategy for any provider is to focus on improving communication with patients. Focus on active listening when the patient is describing their symptoms and sharing medical history, and document as much as possible to prevent confusion later on. Take an empathetic, transparent approach so patients feel comfortable with you and are more likely to be honest about their symptoms.
It can also be helpful to involve the patient's family or caregivers during the appointment, especially when treating older adults or adults with disabilities. These people may be able to share helpful details and perspectives that the patient wouldn't have shared on their own.
Finally, if you work in a multilingual area, consider offering translation services for your clinical practice. This can help prevent miscommunications and help patients feel more comfortable.
Continuing education gives providers access to the latest healthcare research, so they can avoid outdated diagnoses. This should include training on cognitive biases and how to avoid them.
Many providers receive extensive training as medical students, but don't continue that training once they start working full-time. When hospitals and medical systems provide continuing medical education for their teams, providers don't have to seek out this information on their own.
When doctors have more time with each patient, they can take medical histories, conduct examinations, and ask questions without rushing. This helps them get a complete picture of the patient's health to get a diagnosis that is more accurate. Longer appointment times can also help prevent provider burnout.
Important patient details are often lost in the transition between providers, whether that's a shift change for hospitalized patients or the transition from intake nurse to physician in a primary care setting.
To prevent this, implement standard handoff procedures that specify exactly what information should be shared and how the transition should happen. Ideally, handoffs should be done with no distractions, and the transition should be fully documented in the patient's EHR in case of any issues.
Professionals in your facility should be encouraged to refer patients to specialists if they do not think they can provide an accurate diagnosis on their own. This is particularly important in general internal medicine, where providers are often handling a huge variety of medical conditions.
Erring on the side of caution and getting a specialist's opinion can help improve diagnosis accuracy, especially when the patient has an atypical presentation or complicated medical history.
Your team should study diagnostic errors when they happen to determine what went wrong, how it affected clinical outcomes, and how you can prevent it from happening again. Peer review is one important method for identifying diagnostic errors, especially when teams use it alongside chart review and other detection tools. Nonrandom peer review often finds more problems than random review, particularly in radiology and pathology.
In radiology, double reading by a second clinician can improve sensitivity in complex cases and uncover missed or misread interpretations. Peer review also helps organizations meet accreditation expectations from The Joint Commission for evaluating physician performance. Conducting a thorough investigation of every incident will help you strengthen your safety procedures so you don't make the same mistake twice.
Depending on the situation, this might involve conducting a patient record review, interviewing the providers involved, and getting expert opinions. Measuring diagnostic error is necessary for research and quality improvement, but it remains difficult because reporting formats vary, clinicians may hesitate to report their own mistakes, and many studies rely on retrospective analyses that are vulnerable to hindsight bias. Once you've identified the root cause, take action so it doesn't happen again in the future.
We authored a blog specifically covering the 5 most common errors in radiology, read it here!
Health information technology can help busy healthcare professionals make less inaccurate diagnoses and support diagnostic safety. Here are a few examples of how technological innovation has improved patient safety practices:
These tools are most effective when designed with human factors engineering so they fit clinician workflow and reduce usability-related mistakes.
Pairing a provider's expertise with advanced technology provides an extra layer of safety and accuracy when making diagnoses. However, it's ultimately up to the provider to use their judgement and make the final decision.
Most misdiagnoses fall into one of three categories: vascular events, infections, and cancers.
The four types of diagnostic errors are missed diagnoses, delayed diagnoses, wrong diagnoses, and no-fault diagnoses.
Even with appropriate preventative measures, diagnostic errors can still happen. That's why reliable medical malpractice insurance is so essential.
Indigo's AI-powered pricing tailors your premium costs to your practice's risk level. In the event of a claim, Indigo pairs you with trusted local defense teams, while our consent to settle clause means you're always in control.
Get a quote now to see how Indigo can support your medical practice.
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