The Cost of Diagnostic Errors

Diagnostic errors are the most common as well as the most expensive and dangerous errors United States physicians make, according to an emerging study.

These errors lead to roughly 160,000 permanent patient injuries or deaths, according to researchers from Johns Hopkins University, said The Wall Street Journal. The study was published online in the journal BMJ Quality and Safety.

The researchers reviewed more than 350,000 malpractice claims over 25 years and discovered that diagnostic errors comprised nearly 29 percent of claims, more than in other categories including treatment, surgery, or medication. Diagnostic errors were defined as missed, wrong, or delayed diagnosis, according to the Journal. Diagnostic errors also accounted for the largest chunk of claim payments—35.2 percent of total payments, or $38.8 billion, which was adjusted for inflation from 1986 to 2010, said the Journal. Misdiagnoses resulted in death in more than 40 percent of all claims.

The top five patient problems that were associated with misdiagnoses in a 2013 study of primary care visit errors were: Pneumonia, worsening congestive heart failure, acute renal failure, cancer, and urinary tract or kidney infection, the Journal reported. Some of the key reasons for these errors included communication breakdowns in a patient’s first visit to the doctor and the patient not providing appropriate medical history, the doctor not referring the patient to a specialist or failing to follow up with the patient after diagnosis, and misinterpretation of diagnostic tests.

Increased testing may improve detection, but also costs money, may harm patients, and may produce false positive results, said the researchers, who noted that litigation for a missing diagnoses was behind so-called “defensive medicine,” according to the Journal. “There isn’t going to be one magic bullet to solve the problem of diagnostic error, but we can start by consistently monitoring and measuring it,” said lead study author, Dr. David Newman-Toker, an associate professor of neurology at Johns Hopkins.

The researchers acknowledged that claims data are not perfect; however, most true errors tend not to result in claims. Also, previous studies reveal that paid claims are, for the most part, “not frivolous” and malpractice data can be good indicator of the frequency and severity of adverse events. The study looked at closed paid claims from the National Practitioner Data Bank, which was established in 1986 by federal law and maintains information on all malpractice payments, said the Journal.

The numbers of lethal and non-lethal mistakes were about the same and prior estimates of hospital deaths from diagnostic error were about 80,000 annually, suggesting that total diagnostic errors could be about twice that amount, and “it is probably a lot higher than that,” said Newman-Toker, according to the Journal. The highest payments were for severe, permanent neurological damage, although data did not indicate the cause. Newman-Toker said there are some 100,000 missed strokes each year in the U.S. and “There is probably a huge amount of unmeasured disability due to diagnostic error” with strokes, wrote the Journal.

On a related issue, another study just revealed that hospitals actually make money from their own surgical errors because insurers pay hospitals for the longer stays and additional care patients require when preventable surgical errors occur, according to The New York Times. That study was just published in The Journal of the American Medical Association. Study authors suggested that a change to the current payment system, in which poor care is no longer rewarded, might help reduce surgical complication rates.

Research conducted last year indicated that surgeons make thousands of errors yearly in the U.S., a shocking finding based on a study of thousands of surgeries over ten years. The so-called “never events,” said the Journal previously, are those mistakes that should not occur in medicine and include serious blunders such as surgery on the wrong patient and leaving sponges inside patients’ bodies. Research suggests these types of serious medical errors occur with distressing regularity. Lead study author, Martin Makary, associate professor of surgery at Johns Hopkins, said surgical mistakes are “totally preventable.”

We’ve long written about the issue of botched surgeries and diagnostic errors. In prior studies, as in these studies, researchers noted that mistakes occur more often than realized and these types of errors are almost always fully preventable.