Atul Gawande, practicing medical doctor and author of many great lay medical books, wrote The Checklist Manifesto. It's a pragmatic book about getting surgeries right, but it applies to many medical procedures and provides an illuminating look at the process surgeons use to make surgery possible. Gawande goes back to the literal checklist that pilots use as a way to avoid errors.
But maybe these checklists need to accompany doctors the first time they meet a patient. A study led by Dr. David Newman-Toker and published in the medical journal BMJ Quality & Safety suggests that the most dangerous form of medical mistake is diagnostic error – meaning a missed or incorrect diagnosis on the part of the medical provider.
In conducting the study, a group of researchers analyzed 25 years of medical malpractice claims data that came from more than 350,000 individual claims that resulted in settlements and verdicts to the plaintiff. Researchers found that of those 350,000 total claims, as many as 80,000 resulted in death to the patient.
Magnitude & Cost of Missed Diagnosis Cases
The analysis of the medical malpractice records showed, in more than 25% of the cases, the reason for the claim involved some form of diagnosis-related error, totaling more than 100,000 claims. The results of diagnostic errors ranged from minor injuries to permanent injuries, and in some cases even death to the patient.
According to the authors of the study, the total cost of all diagnostic errors analyzed in their research was approximately $38.8 billion. This, according to the researchers involved in the study, was a significantly higher amount than any other type of medical error, which illustrates just how serious of a problem a simple misdiagnosis could end up being for patients.
“Overall, diagnostic errors have been underappreciated and under-recognized because they’re difficult to measure and keep track of owing to the frequent gap between the time the error occurs and when it’s detected,” said Newman-Toker. “These are frequent problems that have played second fiddle to medical and surgical errors, which are evident more immediately.”
Double-Edged Sword of Diagnostic Errors
Dr. Newman-Toker brings up an excellent point about the prominence of “never events” – such as surgical and medication errors – in the area of medical malpractice because of how quickly they can be recognized and attributed to a specific mistake. But often times, medical patients do not become aware of a diagnostic error until much later, and it can sometimes be difficult to trace the origin of the mistake.
There is a double-edged sword to this problem, as is outlined by the researchers involved in the study. Because medical providers’ fear of being held liable for a diagnostic errors, there is always the chance that this fear can result in lead to overuse of diagnostic testing resources, which can be very costly. And since those costs are considered unnecessary and increase the overall burden of healthcare costs, there is also a reason for doctors to be wary about over-prescribing diagnostic services.
According to an article explaining the authors’ thoughts on the issue, “efforts to curb defensive medicine and reform the tort liability system should consider specific policies related to diagnostic error.”