Because we don't see the harm very often, both because they are infrequent as a fraction of all the diagnostic errors we make and because the ones who die don't come back to see us when we systematically missed those events we have this kind of collective delusion that we are usually right.
HLM: What can hospitals or physicians do to improve on these misdiagnoses?
N-T: Although there are a number of solutions that have been proposed, none of them are magic bullets. They range from simple check lists all the way to highbrow, computer-based diagnostic decision support. Those solutions are probably going to have to be used in concert in very dedicated ways to solve particular types of diagnostic error problems.
None of those solutions, all interventions described out there to reduce diagnostic errors, have ever been properly tested at the highest level of did 'I actually save anybody?' They have been proposed and described and tested on paper cases but never actually studied in practice. My view is there are a lot of potential solutions out there. But in order for those solutions to be properly tested we need to measure this on an ongoing daily regular basis.
HLM: Why aren't more hospitals or physicians taking it upon themselves to address this issue?
N-T: There is right now no incentive to track diagnostic errors. In fact there is a disincentive. If no one is required to report it why would a hospital want to look under the rug and find all these dust bunnies; that their diagnostic error rate is 10% to 15 % of all their encounters?
That would look bad. There would be mass panic and confusion, particularly if they are the only ones saying it. That is the problem. Everyone is afraid to look at this issue and as long as no one forces them to look at it they are going to keep it under the rug as long as they can.