Wrong, missed or delayed diagnoses by doctors may be responsible for as many as 80,000 deaths and another 80,000 severe injuries each year, according to a new study published this month by Johns Hopkins University.
These results aren’t surprising to lawyers who represent victims of medical negligence. The stats confirm what our cases tell us: while most doctors are careful and exacting, many doctors can and do make serious mistakes. Their patients and patients’ families suffer acutely from those mistakes, and no lawsuit ever repays the full cost. Doctors know this. Hospitals know this. But seldom do they take full responsibility for mistakes up front and make full restitution to the people they hurt. Instead, patient families often are talked into settling for much less than they need or deserve, or must hire attorneys to wage long legal battles.
The Johns Hopkins study, published online April 24 in the journal BMJ Quality and Safety, was based on an analysis of 350,000 medical malpractice claims over 25 years. It showed diagnostic errors – defined as a missed, wrong or delayed diagnosis– accounted for 29% of the claims. This was larger than treatment, surgery or medication errors, which is usually what people think about when they hear the term medical malpractice.
“This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States,” said lead study author David E. Newman-Toker, M.D., Ph.D., an associate professor of neurology at Johns Hopkins University School of Medicine, in announcing the results. “There’s a lot more harm associated with diagnostic errors than we imagined.”
Even in this report, the researchers try to pin part of the blame on patients and their lawyers, if you can believe it. They say that doctors, out of fear of being held accountable under the law, practice “defensive medicine,” which means more diagnostic tests, which can result in false positives or other harm to patients. They really had to work hard to fit this bit of torturous reasoning into the mix.
The most eye-opening aspect of this report is the high incidence of diagnostic mistakes. Hospitals are not required to report diagnostic errors, unlike other mistakes that lead to adverse patient outcomes. So this is the most recent study that actually measures diagnostic mistakes – and it’s a scary one-out-of-three – at least in terms of cases that result in a legal claim. Because only the most serious and blatant instances of medical malpractice ever make it to a lawyer (and certainly not all of these), the actual number of people harmed by diagnostic errors is certainly much higher.
Johns Hopkins researchers urged the medical community to do a better job of tracking diagnostic errors as the first step in preventing them. They also suggested hospitals and doctors adopt strategies such as using electronic health records to track patient test results, and using software that suggests alternative diagnoses based on symptoms. I certainly hope doctors and hospitals are listening.