Doctor’s Office Diagnostic Errors Cause Substantial Harm: Report

The consequences of misdiagnosing medical conditions during doctor office visits may be a more serious health problem than previously believed, according to the findings of a new study. 

In a report published in the medical journal JAMA Internal Medicine on February 25, researchers from the Houston Veteran Affairs Medical Center indicate that most cases of diagnostic errors during primary care treatment can lead to moderate to severe harm for patients.

An accompanying editorial by Dr. David E. Newman-Toker, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, suggests that the findings indicate that misdiagnosis may cause more patient injuries and deaths than any other medical mistake.

Researchers reviewed medical reports of diagnostic errors using electronic- health records. The researchers looked for cases where patients made an unexpected return visit after an initial primary care visit between October 1, 2006, and September 30, 2007, at two different medical facilities.

They found that the most commonly misdiagnosed conditions were some of the most serious, including pneumonia, congestive heart failure, acute kidney failure, cancer and urinary tract infections, in that order.

The most frequent cause of misdiagnosis was a mistake during the patient-practitioner clinical encounter, which accounted for 79% of medical misdiagnosis incidents. Those mistakes happened when errors were made when taking the patient’s medical history, during the examination or when ordering diagnostic tests. The next most common causes for misdiagnosis were referral mistakes.

“Primary care practitioners (PCPs) manage a wide range of increasingly complex and severe conditions through one or more relatively brief encounters, Thus, it is not surprising that the primary care setting is vulnerable to medical errors,” the researchers concluded. “Diagnostic errors (missed, delayed, or wrong diagnoses) are of increasing concern in this setting.”

Dr. Newman-Toker said in his editorial that the medical community has failed to give the problem the proper attention it merits.

“Diagnostic errors are increasingly recognized as an important source of preventable harm in many health care settings,” he states. “Missed, wrong, and delayed diagnoses have been underappreciated by internal peer review, autopsy reports, and examination of malpractice claims.”

According to Dr. Newman-Toker, most data on misdiagnosis has come from medical malpractice claims, which he says significantly underrepresent the number and severity of misdiagnosis cases. He said that the researchers’ method of looking at unexpected patient returns gave a much clearer image of the dangers of medical misdiagnosis.