More Attention Should Be Given to Diagnostic Errors

It is time for diagnostic errors to get the same attention from medical institutions and caregivers as drug-prescribing errors, wrong-site surgeries, and hospital-acquired infections.

David Newman-Toker, M.D., Ph.D., and Peter Pronovost, M.D., Ph.D., from Johns Hopkins School of Medicine (Baltimore, MD, USA) suggested that diagnostic errors might be reduced by systematically adopting tools such as checklists that help physicians remember critical diagnoses or by making available computer programs known as "diagnostic decision-support systems" that assist physicians in calculating the level of risk of a given patient's having certain diseases. Health systems could further decrease diagnostic errors with low-tech tools such as independent second looks at X-rays and CT scans or rapidly directing patients with unusual symptoms to diagnostic experts.

In an article in the March 11, 2009, Journal of the American Medical Association (JAMA) the team reported that 40,000 to 80,000 hospital deaths per year are the result of misdiagnosis. Tort claims for diagnostic errors--diagnoses that are missed, wrong, or delayed--are nearly twice as common as claims for medication errors.

"Moving away from a model that chastises individual physicians to one that focuses on improving the medical system as a whole could offer big payoffs for improving diagnostic accuracy as well as the cost effectiveness of care," said Dr. Newman-Toker, assistant professor of neurology with joint appointments in otolaryngology, health sciences informatics, epidemiology, and health policy and management at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health. "Right now," he added, "there is often a mismatch between who gets advanced diagnostic testing and who needs it, leading to worse outcomes and higher costs. Realigning resources with needs could improve outcomes at lower cost."

Because diagnostic errors can be tricky to track to their roots, Professor Pronovost, an expert on breaking down complex medical problems, says more research is needed to understand and find patterns in the origins of such errors. Pronovost, a professor of anesthesiology, critical care medicine and surgery, is medical director of Johns Hopkins' Center for Innovation in Quality Patient Care.

Related Links:
Johns Hopkins School of Medicine
Johns Hopkins Bloomberg School of Public Health
Johns Hopkins Center for Innovation in Quality Patient Care