Mistaken or Missed Medical Diagnoses Resulted in $38 Billion in Malpractice Payouts between 1986 and 2010 — Because Most of these Claims Were Probably Legitimate, the Study’s Lead Author Thinks that Medicine Has a Significant Problem

23 April 2013

Citation — to study

Ali S Saber Tehrani, HeeWon Lee, Simon C Mathews, Andrew Shore, Martin A Makary, Peter J Pronovost, and David E Newman-Toker, 25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank, British Medical Journal Quality & Safety [BMY Qual Saf], DOI: 10.1136/bmjqs-2012-001550 (22 April 2013)

Citation — to press release

Johns Hopkins Medicine, Diagnostic Errors More Common, Costly And Harmful Than Treatment Mistakes, Newswise (22 April 2013)

Study methods

The team examined malpractice payouts recorded in the National Practitioner Data Bank between 1986 and 2010.

Clued-in folk will recognize that malpractice payouts usually correlate with provable mistakes and avoidable harms. This is because juries and judges are notoriously likely to be biased in the defendant medical provider’s favor. (I say that as a person with a foot in both camps, who has no ax to grind.)

Findings

Read this part carefully — it is significant:

[R]esearchers estimate the number of patients suffering misdiagnosis-related, potentially preventable, significant permanent injury or death annually in the United States ranges from 80,000 to 160,000.

They found that of the 350,706 paid claims, diagnostic errors were the leading type (28.6 percent) and accounted for the highest proportion of total payments (35.2 percent).

Diagnostic errors resulted in death or disability almost twice as often as other error categories.

Newman-Toker noted that among malpractice claims, the number of lethal diagnostic errors was roughly the same as the number that resulted in permanent, severe harm to patients.

This suggests that the public health impact of these types of mistakes is probably much greater than previously believed because prior estimates are based on autopsy data, so they only count deaths and not disability, Newman-Toker says.

“This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States,” says David E. Newman-Toker, M.D., Ph.D., an associate professor of neurology at the Johns Hopkins University School of Medicine and leader of the study published online in BMJ Quality and Safety.

“There’s a lot more harm associated with diagnostic errors than we imagined.”

Then, there is this even more concerning tidbit

Also from the press release:

The human toll of mistaken diagnoses is likely much greater than his team’s review showed, Newman-Toker says, because the data they used covers only cases with the most severe consequences of diagnostic error.

There are many others that occur daily that result in costly patient inconvenience and suffering, he says.

One estimate suggests that when patients see a doctor for a new problem, the average diagnostic error rate may be as high as 15 percent.

The moral? — As I have written repeatedly, being absolutely certain of anything in medicine is difficult

My guess is that the use of computerized medical protocols will get a boost from these findings.

The age of depending on an artful blend of memory and selectively incomplete knowledge is going to have to fade away, if we are going to be successful in reducing the frequency of missed or wrong diagnoses.

The advantage to competently crafted computer protocols is that they (theoretically) have the ability to incorporate most of medical knowledge to date. And they are more likely to force practitioners to consider or obtain data that they would either miss or prefer not to confront.

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Mistaken or Missed Medical Diagnoses Resulted in $38 Billion in Malpractice Payouts between 1986 and 2010 — Because Most of these Claims Were Probably Legitimate, the Study’s Lead Author Thinks that Medicine Has a Significant Problem