Three medical conditions account for about three-fourths of all major medical malpractices cases involving a diagnostic error, according to new research published in Diagnosis, the official journal of the Society to Improve Diagnosis in Medicine.
Researchers examined 11,592 diagnostic error cases. These included 7,379 with cases which included what researchers classified as "high-severity harms." Of these "high-severity harms," 53% of patients died.
The study found that a vast majority of these "high-severity cases" involved infections (13.5%), vascular events (22.5%), and cancers (37.8%). Researchers have termed these "The Big Three." The most frequent infection in misdiagnosis cases was sepsis, the most frequent vascular event was stroke, and the most frequently misdiagnosed cancer was lung cancer.
The study, conducted by Johns Hopkins University School of Medicine was funded by the Society to Improve Diagnosis in Medicine, a non-profit organization which seeks to facilitate communication between healthcare stakeholders to prevent diagnostic errors.
A variety of physicians were involved in these medical malpractice cases. Roughly half of the cases involved primary care clinicians; the rest involved other specialties, including cardiology, gastroenterology, and neurology, surgical specialties, and diagnostic services like radiology and pathology.
While the study found a significant percentage of the diagnostic errors were the result of mistakes in clinical judgment, Paul Epner, CEO of the Society to Improve Diagnosis in Medicine cautioned against blaming individual physicians and instead advocated for redesigning the current system as the best way to prevent diagnostic errors. The study's conclusion stated that, due to the fact that "The Big Three" accounted for about three-fourths of serious misdiagnosis-related harms, initial efforts to improve diagnosis should focus on vascular events, infections, and cancers, and particularly with respect to cancer.
Diagnostic errors can take many forms. Three of the most common include a failure to diagnose, missed diagnosis, and delayed diagnosis. Failure to diagnose involves a case in which the patient was not diagnosed with a disease, resulting in delayed treatment or total failure to treat. In the case of a missed diagnosis, the patient was diagnosed with an illness or condition different from the one he or she actually had. A delayed diagnosis means the patient's doctor failed to timely notice signs and symptoms of a disease or condition. These types of diagnostic errors can have devastating results for the patient. Delays in diagnosis can often lead to delay in life-saving treatments, with serious impacts on prognosis.