Missed or wrong diagnoses are common in primary care and may
put some patients at risk of serious complications, a new study suggests.
during surgery and in medication prescribing have been at the center of patient
safety efforts, researchers said less attention has been paid to missed
diagnoses in the doctor's office.
Because of how common they are, those errors may lead to
more patient injuries and deaths than other mistakes, according to Dr David
Newman-Toker from Johns Hopkins University School of Medicine in Baltimore, who
co-wrote a commentary on the new study.
Diagnostic errors a major
public health problem
"We have every reason to believe that diagnostic errors
are a major, major public health problem," Newman-Toker said."You're really talking about at least 150 000 people per year,
deaths or disabilities that are resulting from this problem."
For the new study, researchers used electronic health
records to track 190 diagnostic errors made during primary care visits at one
of two healthcare facilities. In each of those cases, the misdiagnosed patient
was hospitalised or turned up back at the office or emergency room within two
The study team found the type of missed diagnosis varied
widely. Pneumonia, heart failure, kidney failure and cancer each accounted for
between five and seven percent of conditions doctors initially diagnosed as
How the study was
Most diagnostic errors could have caused moderate or severe
harm to the patient, the researchers determined. Of the 190 patients with
diagnostic errors, 36 could have had serious, permanent damage and 27 could
have potentially died, according to findings published in JAMA Internal Medicine.
One of the difficulties in making an accurate diagnosis is
certain common symptoms - such as stomach ache or shortness of breath - could
be signs of a range of illnesses, both serious and not, researchers
said."If you look at the types of chief complaints that these things occur
with, they're fairly common chief complaints," said Dr Hardeep Singh, who
led the new study at the Houston VA Health Services Research and Development
Center of Excellence.
"If somebody would come in with mild shortness of
breath and a little bit of cough, people would think you might have bronchitis,
you might have phlegm... and lo and behold they would come back two days later
with heart failure," he told Reuters Health.
Most of the missed diagnoses were traced back to the office
visit and the doctor not getting an accurate patient history, doing a full exam
or ordering the correct tests, Singh's team found. Cutting down on those errors
may require changes in doctor training, for example.
Patients gave their
doctors all relevant information
One thing patients can do, the researchers agreed, is come
to the office prepared to give their doctor all of the relevant information
about the nature and timing of their symptoms. "I do think it's important
for a patient to question or observe the doctor," Newman-Toker said.
"Ask pointed questions: 'What else could this be? What things are you most
concerned about?'" In addition, he told Reuters Health, patients should
"not just assume that once the diagnosis has happened the first time, that
everything is said and done and that it's all over.
You just can't have blind obedience to the doctor's
diagnosis."For example, Newman-Toker said, if people develop new symptoms
or their symptoms worsen, they shouldn't assume everything is fine because
their doctor initially diagnosed something not serious.
Patients should understand there is some uncertainly
involved in a diagnosis, Singh said, especially because symptoms and conditions
can change over time."We need to get patients more engaged in the
conversation with the providers," he said. "I think the main message
is: how do we effectively (make diagnoses) together?"