When researchers looked back at computer data and medical charts to “reconstruct” the diagnostic process, they found there was about a 1 in 20 chance of a missed opportunity for US adults in a given year, according to the British Medical Journal (BMJ), “Quality & Safety.”
As doctors and patients know, a misdiagnosis has the potential to be disastrous. “Although it is unknown how many patients will be harmed from diagnostic errors,” the study says, “research suggests that about one-half of diagnostic errors have the potential to cause harm.”
Often studies use the following definition for misdiagnosis: “missed opportunities to make a timely or correct diagnosis based on available evidence.” So this would include the more jolting experience of receiving the wrong disease as well the perhaps more commonly experienced diagnosis that took longer than it should have to come forth.
Common Misdiagnoses and Errors
To gauge the rate of errors, researchers examined data involving large numbers of patients who visited a primary care physician. They used computer algorithms and data inconsistencies to try to identify potential missed diagnoses. According to the study published in BMJ, diagnostic errors occurred in about 5 percent of outpatients; if generalized to the US, this would be approximately 12 million adults, in a year. The rate of missed cancers, in particular, accounted for a small fraction of that 5 percent, but “delayed cancer diagnosis” is believed to be one of the most harmful and costly types of diagnostic clinical errors.
According to the National Institute of Medicine, examples of frequently misdiagnosed illnesses include celiac disease, heart disease, lupus, lyme disease, and multiple sclerosis; at-risk populations include frail elderly and those with multiple conditions.
Why Doctors Make Mistakes
The study didn’t look at what caused the errors, but surgeon Peter Edelstein, MD, board-certified by both the American Board of Surgery and the American Board of Colon & Rectal Surgery and author of “Own Your Cancer,” thinks our current medical system is largely to blame.
“Doctors are now overwhelmed,” says Edelstein. “There are 10,000 new Medicare enrollees a day, practices are extremely busy; there is not as much time for a physician or a nurse practitioner to spend with patients.”
Edelstein also points to rapid changes in the healthcare model that have doctors and nurses scrambling to adjust. “There’s such a demand for physicians and hospitals to watch every healthcare dollar they spend, that I can’t help but wonder if communication is lagging behind these changes and people are falling through these cracks.” He adds, "This should be a wake-up call to patients that the system is far from perfect and they need to help protect themselves by standing up and asking questions, by seeking second opinions.”
Patients can help ensure an accurate, timely diagnosis, says Edelstein. He offers these tips:
- Trust your instincts. “When we go to the physician’s office with a new symptom or a worsening old one, each of us has a sense of how worried we are about it. If the physician doesn’t give you the response, the plan, or the referral that feels right, say something.” Trust your own instincts, he urges.
- If you’re not getting better, go back. “If what the doctor said isn’t fitting over the next few days, if you’re not getting better based on what you and your doctor agreed to, march back in there.”
- Get the second opinion. If your doctor is defensive or irritated by a request for a second opinion, this is not a good sign, and you may want to look for another doctor. For second opinions, seek out a doctor who’s not affiliated with your doctor’s practice.
- Don’t put off seeing a specialist. “If you wait until you’re not as busy with career and family activities, you won’t be seen, and ultimately, that hurts your family and you,” says Edelstein.
For Family Caregivers
- Ask questions. Today, doctors do not expect patients to be overly deferential. Replace “The doctor is always right” with “We need to work together with our doctor to help ensure an accurate and timely diagnosis.”
- Don’t assume no news is good news. Lab results sometimes get lost. “Whenever you have a test or procedure, ask when the results will be available, and if you haven’t heard within a couple days after that, pick up the phone and call the office.”