An acquaintance of mine was diagnosed with throat cancer, and the doctor assured him that, while serious, the road to recovery would be relatively straightforward and uneventful, because it was Stage I, maybe Stage II.
His wife wasn't convinced, and suggested that her husband seek a second opinion. He went to a prestigious hospital for evaluation, and the verdict was Stage IV—much more serious, disruptive, and disheartening, and yes, it was the correct diagnosis.
Indeed, patients are often encouraged to seek second opinions. But how often are the physicians who misdiagnose the patients even aware of their mistakes? More importantly, what can be done to thwart misdiagnoses in the first place?
A survey released by the National Coalition on Health Care shows that physicians may believe that misdiagnosis, in oncology in particular, is far less common than it really is. This illustrates a definite gap in at least the perception needed to overcome such errors.
The survey was conducted by the NCHC, a Washington D.C.-based group of dozens of health care organizations, and Best Doctors, a Boston-based company specializing in physician programs.
Of the 400 physicians who were asked how often they estimate a misdiagnosis or incomplete characterization occurs in oncology, the vast majority, 60.5%, estimated that it happens "zero to 10%" of the time. Yet published research indicates significantly higher rates of misdiagnosis overall, from 15% to 28% of cases, the study showed.
Of the 400 pathologists, medical oncologists and surgical oncologists who participated in the survey, 79 said that lymphoma was the most misdiagnosed or mischaracterized cancer, followed by breast cancer, 53, and sarcomas, 51.
Referring to the findings, Evan Falchuk, vice-chairman of Best Doctors, says that "it's certainly surprising; [it's] a disconnect [between] what scientific surveys show on misdiagnosis and what doctors in the field say."
"We see in our work, [that] patients who are getting an incorrect diagnosis also often are getting an incorrect treatment plan," Falchuk says. "One of the big problems in healthcare is that there is not enough discussion or data evaluation of misdiagnosis after it occurs to help physicians deal with such issues.
As Falchuk sees it, "there's no feedback loop around this issue in medicine."
For instance, while physicians will gather to discuss morbidity issues following a patient's death, or if there's a terrible surgical complication, "the doctors get together as a team and talk about it, what went wrong, what could have been done better," he adds.
For the most part, however, "the actual issues of misdiagnosis are missing." In an alleged misdiagnosis, such as in the case of my acquaintance, "the first doctor may never know, unless it's reported by a patient," he adds. "There's no systematic way to know, unless someone comes back and says, 'Gee, did you hear what happened?' "
Too often, pathology tests related to cancer now are misinterpreted, which is reflected in the difficulties in diagnosing lymphoma. "Lymphoma is so hard to diagnose primarily because the pathologic classification is so challenging," says David Harrison, a physician at Best Doctors. "The classification schemata are quite complex and doing so accurately often requires a good deal of expertise."
While there are many discussions about medical error, in terms of wasted healthcare dollars, the issue of misdiagnosis referring to the stage of an illness, for instance, is not often the focus of reform efforts.
That should change.
Over the past several years, there have been efforts to explain the misdiagnosis dilemma, and its possible causes, such as:
- Physicians' overconfidence in their diagnostic abilities
- Misplaced complacency
- Not enough time
- Too many subspecialties
- Not having enough patient information
- Improper adherence to protocols
- Incomplete medical records
Jerome Groopman, MD, in the book How Doctors Think and Your Medical Mind, writes that one of the problems is an over-reliance on evidence-based medicine. "Statistics cannot substitute for the human being before you: statistics embody averages, not individuals," he writes.
Although statistics are not the be-all-and-end-all, doctors certainly want and need more data if they are to deal with proper diagnoses, the survey shows. At least 38.5% of respondents, the largest segment, named "fragmented or missing information across medical information systems" as among the most significant barriers to accurately diagnose cancer.
In addition, 36% called for "new or improved pathology tools or resources" to help improve diagnostic accuracy rates in cancer cases. That may speak to the need for more "cohesive, precise medical records and record-keeping" among physicians, Falchuk says.
The physicians in the study also called for incentives for hospitals to participate in confidential misdiagnosis data gathering and reporting, perhaps to include it in part of the hospital accreditation process.
Others said that they favor a voluntary misdiagnosis reporting system, and that the National Institutes of Health should study the misdiagnosis issue. Moreover, they say, there should be a greater number of national events and conferences devoted to misdiagnosis.
Years ago, lawmakers and healthcare stakeholders took steps to begin addressing medical errors, and improving patient safety, Falchuk says. But now there's a chance to complete the circle, and to look into misdiagnosis, he says.
The survey findings are an "opening to take firm steps to begin formally measuring and addressing misdiagnosis," he says.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
