Almost every American will experience an error in diagnosis at some point in life. But the problem has taken a back seat to other patient safety concerns, an influential panel said in a report released Tuesday.
Errors in diagnosis — defined as inaccuracies or delays — account for an estimated 10 percent of patient deaths, hundreds of thousands of adverse events in hospitals each year and are a leading cause of paid medical malpractice claims, the report said.
Such errors can occur with very rare conditions, such as the Liberian man with undetected Ebola who was sent home from a Dallas hospital last September. But there are more common problems, such as acid reflux being mistaken for a heart attack or a pathology report showing cancer that is never communicated to a patient.
Reducing the number of errors won't be easy, in part because there is no standard or required way to track them. Reversing current trends, the report concludes, will require better medical teamwork, training and computer systems.
"Some people go to their graves with a diagnostic error that is never detected," said Robert Berenson, a research fellow at the Urban Institute in Washington, D.C., and one of the committee members who wrote the report. "It's much more difficult to measure than a medication error."
The report, called "Improving Diagnosis in Health Care," is the latest in a series launched 15 years ago with "To Err is Human: Building a Safer Health System," which helped fuel the patient-safety movement. The first report estimated that as many as 98,000 patients die each year because of medical errors. The IOM is part of the private, nonprofit National Academies of Sciences, Engineering and Medicine.
Tuesday's report has a role for just about everyone in the health system, from computer programmers to clinicians to patients. It recommends better teamwork among health care providers, patients and families. Citing the dearth of data about diagnostic errors, the report calls for voluntary efforts to report such problems. Dedicated funding is needed for research, the report says, and hospitals and doctors need to develop better ways to identify, reduce and learn from near misses.
Ironically, the report notes that computerized health records, which can help track and coordinate care, can also become a barrier to efficient and correct diagnoses.
The systems, it says, often aren't compatible from one physician's office to another or among hospitals. Auto-fill functions sometimes enter the wrong information. And the sheer volume of inputs and alerts can overwhelm medical staff.
The report cites a study of emergency department staff that found clinicians spent more time entering information into computers than taking care of patients. Another study found that while electronic health records provide alerts in response to abnormal diagnostic test results, 70 percent of medical staff surveyed said they receive more alerts than they could manage.
Making the systems more efficient and allowing patients more timely access to their own medical records to check for and correct errors "could be a game changer," said Berenson.
Indeed, patients "are going to be critical to the solution," said Dr. Michael Cohen, another report author and a pathologist at the University of Utah in Salt Lake City. "There's a real opportunity for patients to advocate for themselves and at the same time to challenge the health care providers about the diagnosis being made."
Helen Haskell, who formed Mothers Against Medical Error after her 15-year-old son died because of a hospital medication error, said she was pleased the report focused on better teamwork and communication. She also said patients need better access to their records — particularly hospital records.
Consumers, she said, should be prepared to ask questions about their diagnoses. "What else can it be? Does this diagnosis match all my symptoms?" are two of the best questions to ask, said Haskell. If there is any doubt, she said, "people should get a second opinion."
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