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Diagnostic Errors Common, Costly, and Harmful

John Commins, for HealthLeaders Media, April 23, 2013

Unfortunately, the ones who don't come back are those who sought care elsewhere and got better treatment or unfortunately some of them ended up in a body bag. We never find out about those patients and that is worse in places like the emergency department, where they get virtually no follow-up on any of their patients either.

But it is also bad in primary care and other places where there isn't a mechanism whereby the system ensures that you will get follow up on all the patients who don't come back. We developed this delusional belief that because we are seeing patients in follow-up who are doing well that we must be right most or all of the time.

The other thing that is the fool's gold here is that most of the time our diagnostic mistakes don't harm patients. So we probably have a huge rate of diagnostic error. If you just look at autopsy data where the studies are reasonably clear and crisp around this issue 5% of autopsies done in hospitals suggest a Class 1 diagnostic error.

That means those are patients who died but had their diagnosis been correct they 'coulda, shoulda, woulda' left the hospital alive instead of in a body bag. That seems like a relatively small number. Certainly you can say 95% were right and that sounds good. But there weren't 95% all right. There is another 20% Class 2 error rate where we made major or significant misdiagnoses.

Then you start getting into other misdiagnoses that get further away from harm the rates get up into the 50% plus range. We are probably making diagnostic errors all the time, but we are lucky because the conditions don't kill people or it gets discovered later.

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2 comments on "Diagnostic Errors Common, Costly, and Harmful"


Marcia C (11/30/2013 at 3:55 PM)
11.30.13 Kaiser failed to treat me for a deadly infection Klebsiella Pneumoniae for 3.5 months despite my pleas of urgency, frequency and pain. I had to demand a referral to a urologist and another lab test with culture. Docs thought I had female "overactive bladder syndrome" and referred me to pelvic floor physical therapy and Kaiser gave me a discount on "glide and silk creams" and I was told to lie on two little balls and relax my psoas muscles. One error after another resulted in recently 10 days of hospitalization for sepsis, kidney issue and a pulmonary embolus from PICC line. I almost died. Terrible experience

WrongDiagnosis (4/23/2013 at 5:14 PM)
I had a wrong diagnosis at Kaiser and had to get the correct diagnosis out of system, and then fight Kaiser to have them treat me. I later spoke with a doctor working on the EHR system at Kaiser. They don't have a diagnosis area in it, so doctors have to read through the previous doctors' notes without any sort of summary of what has been ruled out. I would suggest for serious cases there is a diagnosis "tab" in the EHR. This is the model of our country's EHR system; and thousands will be harmed by it. This is a serious issue in medicine and must be addressed. I lost a year of my life, I guess I'm lucky I didn't die.