A physician in our family recommended “How Doctors Think” by Jerome Groopman. Dr. Goopman’s book will give you insights that will serve you well for the rest of your life (and could help you survive longer too). Diagnosis can be very challenging – personally I hope not to be one of those difficult cases. But even everyday cases can be misdiagnosed – and the US system is poorly equipped to detect and correct these errors.
Recently Laura Landro, writing for WSJ, surveyed the current US situation. The graphic at left gives just a glimpse of how serious the problem is. There are no large-scale studies, in part because accurate results would be very expensive to obtain. How do you detect an incorrect diagnosis? How do you know the consequences if you detect such a case?
Perhaps most importantly, how does the patient get access to profiles of doctors and institutions so they can avoid “Dr. Death” and improve their chances of good treatment? Here’s an abbreviated excerpt of Ms Landro’s report (bear in mind the data presented is one study of 190 cases):
“Diagnostic error is probably the biggest patient-safety issue we face in health care, and it is finally getting on the radar of the patient quality and safety movement,” says Mark Graber, a longtime Veterans Administration physician and a fellow at the nonprofit research group RTI International.
In addition, the Society to Improve Diagnosis in Medicine, which Dr. Graber founded two years ago, is working with health-care accreditation groups and safety organizations to develop methods to identify and measure diagnostic errors, which often aren’t revealed unless there is a lawsuit. In addition, it’s developing a medical-school curriculum to help trainees improve diagnostic skills and assess their competency.
Large health-care systems are mining their electronic records for missed signals. At the Southern California Permanente Medical Group, part of managed-care giant Kaiser Permanente, a “Safety Net” program periodically surveys its database of 3.6 million members to catch lab results and other data that might fall through the cracks.
In one of the first uses of the system, a case manager reviewed 8,076 patients with abnormal PSA test results for prostate cancer, and more than 2,200 patients had follow-up biopsies. From 2006 to 2009, 745 cancers were diagnosed among those patients—and Kaiser had no malpractice claims related to missed PSA tests.
The program is also being used to find patients with undiagnosed kidney disease, which is often found via an abnormal test result for creatinine, which should be repeated within 90 days. From 2007 to 2012, the system found 7,218 lab orders placed for patients with an abnormal test that had not been repeated. Of those, 3,465 were repeated within 90 days of a notice to patients that they needed a repeat test, and 1,768 showed abnormal results. The majority, 1,624, turned out to be new cases of the disease.
Michael Kanter, regional medical director of quality and clinical analysis, says the system enables clinicians to go back “as far as is feasible to find all of the errors that we can and fix them.”