By Sandeep Pandey
Diagnosis is the primary and most critical step toward a successful treatment—however, diagnostic errors can take a huge toll at both an individual and system level. According to data collected by ImproveDiagnosis.org, diagnosis is a challenging task for the medical fraternity. The number of diseases stands at 12,420-plus, which present 250-plus chief complaints or symptoms. And there are more than 5,000 different types of tests. Therefore, pinning down a set of symptoms to a particular disease is prone to both human- and system-caused errors.
In data published by the U.S. Institute of Medicine 2015 and BMJ Quality & Safety 25-Year Summary of US Malpractice Claims, 2013, diagnostic errors lead to nearly 40,000 to 80,000 deaths each year in the United States. And this doesn’t include the other sufferings short of death that patients undergo as a result incorrect diagnoses. In fact, studies find that diagnostic errors range from 5% to 15%, on average, for multiple diseases.
A Harvard Medical Practice study cited that diagnostic errors accounted for 17% of preventable mistakes in a hospital setting. Likewise, another study that analyzed autopsies found that approximately 9% of patients suffered from a major diagnostic error that wasn’t detected while they were alive.
From a financial standpoint, the burden of misdiagnosis is huge. Claims for diagnostic-related errors in malpractice cases amounted to a staggering $38 billion between 1986 and 2010. Note: This doesn’t include the added medical costs of treating a patient who has suffered from a misdiagnosis and incorrect treatment.
Reasons for Diagnostic Errors
Contrary to what you may think, physician incompetence or inability is not usually the primary source of diagnostic errors. In fact, a study carried out by Graber 2005 found that diagnostic errors are due to multifactorial reasons that involve both cognitive and system errors, including communication errors. The primary cause of diagnostic errors is a combination of both cognitive and system errors, creating a perfect storm where numerous things go wrong.
Cognitive errors are those that occur due to flaws in the physician’s thinking process. Some common cognitive pitfalls include being bias from past experiences, prematurely jumping to conclusions, getting influenced from subtle clues, or being overconfident about the accuracy of a particular test. System errors include events where a miscommunication takes place or a critical report is lost in the diagnostic process.
Error Types in Diagnosis
A diagnostic error can be one of two types: a false negative or a false positive error. The latter error is one where the diagnosis incorrectly leads to citing a disease when it’s not present. A false positive error leads to increased worry and time and money spent on confirming a condition. In some cases, it may also result in an improper treatment. False negative errors, on the other hand, are mostly fatal because the diagnosis fails to note disease in the affected individual. This causes a costly delay in providing a timely and correct treatment and can lead to death.
Although diagnostic errors take place in all specialties, they’re more common in some. Diagnostic errors are found to be the No.1 cause of medical malpractice claims in primary care, radiology, emergency medicine, and several medical sub-specialties. A 20-year study that analyzed errors in radiology cited an error rate of between 2% and 20% based on the type of radiological test. Moreover, breast cancer is the diagnosis that sees the most claims. Fatal diagnostic errors are also common in strokes, heart attacks, and other cancers.
Preventing Diagnostic Errors
A good way to continually minimize diagnostic errors is to enable a feedback mechanism for physicians concerning when and how their diagnoses went wrong. A major challenge today is that even the best facilities lack a systematic and reliable feedback process. Plus, autopsies, which have been an excellent teaching mechanism for centuries, are on the decline. Another reason cited for the lack of feedback systems is medical schools’ reluctance to have such transparent systems. For instance, it’s difficult for a particular medical facility to measure and admit their diagnostic error rate when no other facility is doing it.
Another area of improvement lies in fixing system errors and, in particular, communication errors. Processes can be devised to ensure that proper communication takes place between physicians during patient handoffs.
Technology-assisted diagnosis can also play a key role in preventing cognitive errors.. As noted earlier, these errors take place due to natural biases that play in a physician’s head. That’s why having a cost-effective mechanism that allows multiple doctors to analyze a diagnosis can help to overcome the biases of a single doctor.
Cognitive Error Reduction Through Crowdsourcing
The age-old adage that two eyes are better than one forms the basis of error reduction by involving multiple doctors, pathologists, or radiologists in a diagnosis process. Double-reading—where two or more radiologists pass through a report—has been proven to reduce errors. In Ireland, for instance, all MRIs related to breast cancer screening are automatically double-read.
Since it may be costly for health care institutions to have redundant staff for multiple passes on a report, the choice is often left to a patient. In matters of serious illnesses, however, a patient may certainly benefit from having a second or third opinion on her case.
Diagnose.me is another option. This company allows patients to seek opinions from independent radiologists on various imaging-based diagnoses, such as CTs, MRIs or x-rays. Since it’s a global platform, Diagnose.me allows patients to leverage services of equally or more-qualified radiologists on a global basis. Due to the cost-of-living differences, getting a second opinion through an out-of-pocket model may be feasible for patients in the US.
HealthClues is another platform focused on orthopedic specialties, which helps patients identify all clues that lead to a successful diagnosis and, ultimately, a successful treatment. It allows a patient to overcome a possible cognitive bias of a single physician by letting him or her seek a medical opinion from multiple experts. The platform also ensures that the participating physician is provided access to all relevant reports to ensure that all pertinent information is available for a sound medical opinion. HealthClues’ consultation process also ensures that physicians don’t have access to information about a prior diagnosis since such knowledge can lead to a biased decision.
Both of these platforms leverage technology that makes it easy for patients to share their medical information with a global panel of physicians. The uniformity of the reports format, such as MRI or x-ray reports, and a similar level of physician training enables a cost-effective and sound diagnostic report.
In conclusion, diagnostic error reduction still has a long way to go. But by making a concerted effort through process and technology-driven initiatives, it’s possible to reduce diagnostic errors that lead to an immense burden on both the patient and health care system.
Cognitive errors mainly arise due to dependency on a single physician, but they can be easily overcome by making independent diagnosis possible from multiple physicans. When the opinions don’t match, it can lead to further investigation and better diagnostic accuracy.
Sandeep Pandey is the founder of HealthClues.