Diagnostic Errors

Posted by in Blog, Patient Safety

Diagnostic Errors

Preventing Diagnostic Errors

 

An article I read today online at the Journal of the American Medical Association network about diagnostic errors brought back painful and frustrating memories. As the parent of a child who suffered a life-altering delay in diagnosis, I have worked for over a decade to educate the public about the role they can, and must, play in ensuring safe medical care for themselves and their loved ones. Diagnostic issues continue to occur frequently and often with serious consequences and cost.

Our Empowered Patient ® Hospital Guide devotes an entire chapter to the diagnostic process due to the fact that I am personally aware of the challenges patients and their loved ones face – and the actions they can take to make sure that everyone involved is communicating and keeping a broad focus. The JAMA article identified 68 unique missed diagnoses in 190 cases of outpatient care.  The areas that the public can learn from are as follows:

 

Common Missed Diagnoses                          Symptoms Involved in Diagnostic Errors

 

Pneumonia (6.7%)                                                  Cough                             Leg swelling

Congestive Heart Failure (5.7%)                          Abdominal Pain             Fatigue

Acute Renal Failure (5.3%)                                    Shortness of Breath      Foot pain

Cancer (primary) (5.3%)                                         Back Pain                       Knee Pain

Urinary Tract Infection (4.8%)                              Chest Pain                      Dizzy/headache

 

To protect yourself, you must first be aware of the areas in which you are vulnerable. Identifying the most common problem areas is important for patients as well as providers and provides many learning opportunities. If you take a loved one to a hospital or a provider and you suspect one of the conditions listed above, be sure to:

  1. Communicate your concerns to the provider and be specific. Ask questions such as “Could this possibly be pneumonia?” “How can we be sure?”
  1. If your loved one has had a similar condition before, be sure to mention it. Consider statements such as “My father had very similar symptoms last year when he was diagnosed with heart failure.”
  1. If possible, have access to online information while you are seeking medical care via a smart phone or tablet device. You may need to do your own research right on the spot to help answer questions that may arise.
  1. If you are given a definitive diagnosis, always ask “Is there anything else this could be?”Be aware that the diagnosis may not be written in stone.
  1. Write down the complete name of the diagnosis in medical terminology and research symptoms and treatments to be sure they match the patient’s condition.

Contributing Factors to Diagnostic Errors

  1. Inadequate patient-provider communication
  2. Incomplete medical history documentation
  3. Failure to examine the patient
  4. Failure to order diagnostic tests
  5. Follow-up and tracking diagnostic information
  6. Interpretation of tests
  7. Patients not referred to a specialist

86.8% of the diagnostic errors in the study mentioned above were “associated with potential for moderate to severe harm.” Improving the patient-provider encounter is a vital component to reducing the risk of harm from a missed diagnosis. To that end, here are a few things patients and their loved ones can do:

  1. Health care visits tend to be brief, so arrive prepared. Bring a written list of all symptoms and how often they occur, how long they have been present, and your questions and concerns. Try to limit your questions to a sentence, or two – be very specific.
  1. Be able to provide a complete medical history. It will be nearly impossible to remember every detail without keeping a written or online record, so make the commitment to start and keep a personal health record (PHR).
  1. Ask your provider to examine you – listen to your cough, look in your throat, take and evaluate vital signs, etc.
  1. Understand why each test is being ordered and what information it will provide. Ask “How will this information affect my treatment plan?”
  1. Research which tests are appropriate for your condition. If your research leads you to a test that is not being ordered, ask if it would be helpful.
  1. Don’t assume that “No news is good news!” Follow up on all your test results and ask for a written or online report for your personal heath record.
  1.  Ask if it would be beneficial to involve a specialist in your care. Consider a second –or third – opinion if your diagnosis is unconfirmed, serious, or rare. Always pay attention if your intuition is telling you that something just isn’t right.

For more detailed information, please download the free Empowered Patient® Hospital Guide.