Provider Spotlight: Dr. Mandel, ER Maverick & Locum Tenens Physician

Dr. Ken’s Corner: Errors in Diagnosis: Under the Microscope

“A patient with abdominal pain dies from a ruptured appendix after a doctor fails to do a complete exam. A biopsy comes back positive for prostate cancer, but no one follows up when the lab result gets misplaced. A child’s fever and rash are diagnosed as a viral illness, but they turn out to be a much more serious case of bacterial meningitis,” (The Wall Street Journal, November 18, 2013).

According to researchers at Johns Hopkins University, diagnostic errors are the number one cause of malpractice claims in the United States. Every year, as many as 160,000 patients either die or suffer permanent injury from misdiagnoses. The good news is that this issue “is finally getting on the radar of the patient quality and safety movement,” says Dr. Mark Graber, founder of the Society to Improve Diagnosis in Medicine.

As a result, health care providers are finding innovative ways to prevent diagnostic errors. Computers can red-flag test results and “trigger” queries of patient records lacking documented follow-up. A pilot program at the Houston VA Hospital looked at 600,000 charts of patients seen at the VA facility in 2009 and 2010. “This program is like finding needles in a haystack, and we use information technology to make the haystack smaller and smaller so it’s easier to find the needles,” says Dr. Hardeep Singh, the research team’s leader.

Companies are rolling out new medical devices that may prevent errors in diagnosis, focusing on doctor-friendly technology for use in the office setting. Hand-held ultrasound equipment and microfluid lab testing, for example, can help doctors make more rapid and accurate diagnoses while avoiding the need to send the patient elsewhere for tests and procedures. This lessens the risk that a lab study will be delayed or overlooked.

But, we can’t fall into the trap of thinking that technology is “the answer.” It’s still no substitute for a thorough history and physical. Instead of locking in on what may seem obvious, it’s also important to question our initial diagnosis: “What else could this be?” And, if there’s any doubt, we should be quick to get a second opinion to avoid errors in diagnosis.

(Reference: Landro, L., “The Biggest Mistake Doctors Make,” The Wall Street Journal, November 18, 2013).