Three diagnostic mistakes account for 75% of malpractice claims

Just three categories of diagnostic errors account for roughly 75% of all serious misdiagnosis-related harms to patients, according to a new study published in Diagnosis. Diagnostic errors are a big problem in the U.S., though estimates vary widely, from 40,000 to 4 million patients affected annually.

The three categories include vascular events, infections and cancers. In addition, about half of the serious harms from diagnostic error were attributable to one of 15 disease states. The results were true across a variety of settings. Half of the high-severity harms caused and half caused serious, permanent disability.

“These results suggest considerable progress could be made toward reducing overall serious misdiagnosis-related harms by improving diagnostic decision-making for a relatively small number of high-risk conditions in just a few clinical settings,” lead author David Newman-Toker, MD, of the Johns Hopkins School of Medicine, and colleagues wrote.

According to researchers, diagnostic errors are the “most common, most catastrophic and most costly of serious medical errors” in malpractice cases.

The study examined 11,592 diagnostic error cases over a 10-year window, with the most frequent disease in each category reported as stroke, sepsis and lung cancer. In 85.7% of cases, the causes of diagnostic error were clinical judgement factors.

“This result accords with prior work indicating that the vast majority of diagnostic process failures happen in bedside assessment and clinical reasoning … and points to a need for solutions that support better bedside clinical decision-making,” Newman-Toker et al. wrote.

Some of these solutions include device-based decision support or automated image interpretation, as well as improved diagnostic education. Higher investments in preventing misdiagnosis could also be beneficial.

“Our current annual federal investment to fix diagnostic errors is less than what we spend each year researching smallpox, a disease eradicated in the U.S. over half a century ago," Newman-Toker said in a statement. "If we devoted appropriate resources to tackling misdiagnosis of the 'big three' diseases we identified, we could potentially save half of the people who die or are permanently disabled from diagnostic errors."