April 23, 2013

Must-read: Adding up diagnosis errors

Laura Landro’s column in the Wall Street Journal today is a must-read: Adding Up Diagnosis Errors. Why? Let me count the ways:

  1. She is one of the most thorough, informed health care reporters around.
  2. She is covering an important topic that should be of interest to everyone.
  3. The study is behind a paywall so media coverage is the only way the general public can learn of the findings.

Her opening line:

Mistakes diagnosing patients are the most common, costly and dangerous errors made by doctors in the U.S. and result in permanent injury or death for as many as 160,000 patients annually, a new study found.

My eyebrows shot up and I immediately searched for the full-text article, which is unfortunately behind a pay wall:

25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank (BMJ Quality and Safety; April 22, 2013)

I also spent a few minutes digging through my own tweets since I remembered a similar study in JAMA recently. I should have just listened first to the podcast accompanying Landro’s column, since she mentions it:

Types and Origins of Diagnostic Errors in Primary Care Settings (JAMA Internal Medicine; March 25, 2013)

And an accompanying commentary:

Measuring Diagnostic Errors in Primary Care: The First Step on a Path Forward

The quote that jolted me when I read it in March:

“Most diagnostic errors are linked to clear defects in bedside history taking, physical examination…”

Which led me to tweet:

  1. Is it any wonder that 35% of U.S. adults go online to get a jump on a diagnosis?
  2. Is it any wonder that so many U.S. adults track some aspect of health, esp those with serious conditions?

But now, looking back, I’m intrigued by this line (visible in the free summary of the commentary):

“Missed, wrong, and delayed diagnoses have been underappreciated by internal peer review, autopsy reports, and examination of malpractice claims.”

Today’s news, of course, focuses on malpractice claims, so I have lowered one of my eyebrows (I’m an optimistic skeptic, so this is a pretty frequent facial exercise).

I also feel like a pay wall ninja for clicking through to read a correction to the JAMA commentary, which contains this key paragraph:

“Nevertheless, with more than half a billion primary care visits annually in the United States, if these data from Singh et al are generalizable, at least 500 000 missed diagnostic opportunities occur each year at US primary care visits, most resulting in considerable harm. If error rates at the half-billion non–primary care visits are similar, the total could be more than 1 million. If even 10% of these (100 000) are easily prevented, and combining this figure with autopsy-based estimates of preventable US hospital deaths from diagnostic errors (40 000/y to 80 000/y), more than 150 000 patients per year in the United States might have undergone preventable misdiagnosis-related harm.”

That is pretty close to the 160,000 patients per year estimate cited in today’s study.

Finally, I have to point out another favorite quote from Landro’s column since it captures why I love research:

“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,” says David Newman-Toker, lead author of the study and an associate professor of neurology at Hopkins.

Indeed. Swap out “problem of diagnostic error” and swap in “question of participatory medicine” and you have my raison d’être. Understanding how people gather, share, and create information is an essential ingredient to understanding the future of medicine.

Join a discussion on my personal blog.