Scary data about bum medical diagnoses

Be forewarned: The following stats are not for the faint of heart.

— at least 40,000 people a year (and perhaps as many as 80,000) die in U.S. hospitals due to complications of misdiagnoses (resulting from no treatment, delayed treatment or wrong treatments).
— one-in-20 autopsies uncover problems that could have been averted — saving the patients’ lives — but weren’t, owing to misdiagnoses
— a Harvard Medical Practice Study found that physician errors were about 60 percent more likely to be diagnostic than due to meds, and misdiagnoses about 50 percent more likely to be negligent than not.
— lawsuits for misdiagnoses are about twice as common as for drug-related errors — and result in the biggest payouts by insurance companies.

David E. Newman-Toker and Peter J. Pronovost of Johns Hopkins University School of Medicine share these unsettling numbers at the top of their March 11 commentary in the Journal of the American Medical Association.

The authors offer five tactics by which hospitals, and medicine generally, might minimize diagnostic errors. They include things like avoiding an over- or underestimation of the likelihood some condition will occur (because physicians will tend to assume they’ve encountered the higher probability event and treat for it). And focusing on the harm attributable to misdiagnoses, not the number of misdiagnoses alone — since the harm is easier to identify, and also matters most.

I would actually have outlined all five of their suggestions if I could understand them. Unfortunately, the authors’ language proved anything but crystal clear. Consider, for instance: “If systems solutions ultimately sidestep cognitive psychology, grouping errors based on clinical context rather than the cognitive defect may prove more productive. A context-based approach that focuses on the nature of the clinical problem helps identify potential systems solutions and possible pathways for research.” Huh? Do they really expect overworked physicians to read that and experience some epiphany?

Luckily for me, in the above case Newman-Toker and Pronovost offered an example: a patient who claimed to hear his eyes move. Rather than assuming that patient is crazy, the docs suggest, try an Internet search. It should identify a rare but treatable superior canal dehiscence syndrome (yep, that’s really the name of some weird inner-ear condition) that can cause just such noisy eyes.

Studies of diagnostic errors are fairly rare, the researchers point out. But that could change soon. The federal Agency for Healthcare Research and Quality, they note, has targeted misdiagnoses as a research priority. And President Obama’s stimulus package includes big bucks for computerizing health records. With the movement of computers into doctors’ hands (and pockets), their ability to cross-check symptoms — not to mention the efficacy of therapies for particular diagnoses and patient groups — should improve.

But in the mean time, there are lessons in this for us. We really need to question our health-care team when their prescribed treatments or wait-and-see approach don’t make us better. We should be prepared to seek second, third and fourth opinions — from our doc or from other physicians. We should enlist our friends and family to scout the Internet for clues to our symptoms, things we can share with our doctors during our visits. The biggest lesson: Complacency does not seem a wise policy.

Janet Raloff is the Editor, Digital of Science News Explores, a daily online magazine for middle school students. She started at Science News in 1977 as the environment and policy writer, specializing in toxicology. To her never-ending surprise, her daughter became a toxicologist.

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