The People's Perspective on Medicine

Show 1186: What Happens When Doctors Make Diagnostic Errors?

No one knows quite how many diagnostic errors doctors make each year, but the number is high. Some have serious or deadly consequences.
David Newman-Toker, MD, PhD, Director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence
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What Happens When Doctors Make Diagnostic Errors?

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When you get sick, you need a diagnosis. If the diagnosis is wrong, the treatment won’t be appropriate. What happens when doctors make diagnostic errors? We talk with a leader in the Society to Improve Diagnosis in Medicine about his recent research.

What Diagnostic Errors Are Most Serious?

Clinicians make an estimated 12 million diagnostic errors every year, although the number might be even higher. As many as half a million to a million of these misdiagnoses result in serious patient harm. Dr. David Newman-Toker and his colleagues examined a database of settled malpractice claims to determine which conditions account for the preponderance of serious harms due to misdiagnosis. They found that the vast majority could be classified under one of three rubrics: cancer, cardiovascular events and infections.

How Can Doctors Make Fewer Diagnostic Mistakes?

Frequently, clinicians who have made diagnostic mistakes never hear about them. With an estimated 12 million misdiagnoses each year, however, we could count these errors among the leading causes of death in the US. Such blunders are rarely if ever listed on the death certificate as a cause of death. Would it help if they were? Should there be an Institute for Diagnostic Error Prevention among the National Institutes of Health?

How Can Patients Help Doctors Avoid Diagnostic Errors?

Systems errors that interfere with tests being done or the results reported in a timely fashion can contribute to diagnostic problems. However, many of the errors in diagnosis involve problems with clinical judgment–the way doctors approach the problem and the questions they ask, as well as the way they factor in the answers. One simple thing the patient can do is ask: “What is the worst thing this could be?” The appropriate follow-up question is: “Why do you think it is NOT that?” Patients should expect a serious answer based on their (accurately described) symptoms or lab work. A dismissive “I’m the doctor” answer is not adequate.

Close collaboration between physicians and patients gives everyone the best chance of avoiding diagnostic mistakes. If the doctor does not have a reasonable response, seek a second opinion.

What Patients Should Do to Help:

Dr. Newman-Toker recommends that patients take the following steps to minimize the chance of being misdiagnosed.

  • Before the visit, prepare a concise but complete list of symptoms, with a timeline.
  • During the visit, ask questions about anything you don’t understand. Be sure to ask what is the worst thing that the symptoms could signal and how the clinician will rule that out.
  • After the visit, stay vigilant. If you don’t get better, get back in touch with the health care provider. Instead of simply saying the treatment didn’t work, suggest that you are not sure the diagnosis is correct because the treatment isn’t working. If necessary, seek a second opinion.

Top Ten Questions to Ask to Reduce Diagnostic Errors:

  1. What are my primary concerns and symptoms? (to make sure the doctor understood what you said)
  2. How confident are you about this diagnosis?
  3. What further tests might be helpful to improve your confidence?
  4. Will the test you are proposing change the treatment in any way?
  5. Are there any findings or symptoms that don’t fit your diagnosis or that contradict it?
  6. What else could this be?
  7. Can you facilitate a second opinion by providing my medical records?
  8. When should I expect to see my test results?
  9. What resources can you recommend for me to learn more about my diagnosis?
  10. May I contact you by e-mail (or another method) if my symptoms change or if I have an important question? Contact information?

You will find these questions and many more in our book, Top Screwups Doctors Make and How to Avoid Them.

This Week’s Guest:

David Newman-Toker, MD, PhD, is Director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence and Director of the Division of Neuro-Visual & Vestibular Disorders in the Department of Neurology. He is also Professor of Neurology at Johns Hopkins University School of Medicine.

He is a leader in the Society to Improve Diagnosis in Medicine. The national conference is November 10-13, 2019.

His article, “Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers” was published in Diagnosis. The photo is courtesy of Johns Hopkins Medicine.

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I was recently diagnosed with psoriasis. This was after MONTHS of my dermatologist treating me for ringworm based on her cursory exam. And yes, I gave a history/timeline and asked questions.

It was my family dr. who said, “That doesn’t look like ringworm….” and got me in to see her before my scheduled follow-up. This time, she did a biopsy. Hence the correct diagnosis.

No, this isn’t a life-threatening situation (though I have about 70 areas on my body that are affected, some small and others huge). But what got me was that, instead of admitting that she dropped the ball, she said, “WE ALL thought this was ringworm,” as if my primary guy suggested it. (I corrected her on that.)

Why didn’t she start off with a biopsy? Why didn’t she walk back her original diagnosis and instead throw my primary under the bus? Now I am not even sure this course of treatment is correct.

I understand the mis-diagnostic errors all too well. I had gallbladder disease for over a year. I was diagnosed with various ailments. Finally the GI doctor gave me a test for my gallbladder, and I had it removed. 6 months later I had abdominal pain and was told I had IBS. I later talked with the Dr’s nurse and explained again my pain. The nurse told me to go to the Emergency room. That night I had emergency surgery of my appendix. Then 6 months later more discomfort (I had a history of diverticulitis) and had to have 12 inches of my colon removed. This was a big learning experience. Now I will be more aware if the doctor is listening to me and paying attention.

Hello,
I as well as several family members have been misdiagnosed by our primary doc AND specialists many times over the years. My father died all alone in a hospital bed from asphyxiation due to being given far more medication than he was supposed to get – miscommunication amongst doctors/staff. He was supposed to come home the next morning. When we asked for the hospital records, they mysteriously were missing from his file.

The doctors just DON’T LISTEN to their patients. They don’t have the time or the interest. I despise going to the doctor for anything anymore, and will take matters into my own hands (with help from you!) whenever possible.

THANK YOU. I have been the patient with several missed diagnoses and concomitant years of misery, caused by physicians who turned on ME when their errors were reported. The patient shouild not have to be the one who 1. confronts the physician and 2. then suffers double consequences from their error!

My nephew was admitted last Tuesday for extremely low blood pressure. He ended up in ICU on a ventilator, and we were told that he wasn’t going to make it through the night. It was a very emotional evening! He pulled through by the grace of God and lots of prayers! He ended up on dialysis for 5 days and was on lots of medication and feeding tube also. Being a woman of faith I kept praying, and so did my church family and friends. He did come off the ventilator yesterday, praise God! But they have absolutely no clue what caused any of this? And they have no diagnosis? I find that hard to believe. 2+2 doesn’t equal four! We are concerned because he’s only 49 years old. We don’t want him to go through this again! Any suggestions would be helpful.

For many years my blood pressure was normal. Then my doctor decided to put me on a different pill. I switched doctors five times before I got my blood pressure back to normal which took six years. Each doctor told me to keep taking the medicine even when my heart was racing 100 miles a minute. If one pill did not work, then they would give me a pill for the side effects. I find the biggest problem with doctors is that they DO NOT LISTEN and they are against the patient taking supplements.

I went to see my Primary Dr. because I was so short of breathe. She promptly told me to increase my use of Dulera. That did not help.!! I made an appointment with the Cardio Clinic, and within a hour they found three blood clots: one in my leg, two in my lungs. My Cardio Dr. told me I could have dropped dead a year ago. This was actually the third mistake my Primary Dr.made. I Thank The Good Lord she has since retired !!

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