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Malpractice Study Links Doctors' Basic Errors to Wrong Diagnoses

A study published in the October 3, 2006 issue of the Annals of Internal Medicine shows a correlation between doctor errors and incorrect diagnoses that lead to patient harm. This study differs from others in that it does not focus on errors in treatment, but rather errors in diagnosis that then lead to wrong care and harm.

Also covering this study is an article from the October 2, 2006 Associated Press that appeared in many news outlets. Researchers in this study reviewed 307 completed malpractice cases, of which 181 were reported to involve errors in the diagnosis that then resulted in harm to the patient. A high majority of these cases were cancer patients. The reviews were from malpractice insurance companies files.

The results of the reviews showed that of the 307 total claims 59 percent involved a diagnostic error that harmed patients. Of these 181 cases another 59 percent (106 of 181) of these errors were associated with serious harm, and 30% (55 of 181) were of such a serious nature that they resulted in the death of the patient.

The results showed that some of the more common errors involved "failure to order an appropriate diagnostic test (100 of 181 [55%]), failure to create a proper follow-up plan (81 of 181 [45%]), failure to obtain an adequate history or perform an adequate physical examination (76 of 181 [42%]), and incorrect interpretation of diagnostic tests (67 of 181 [37%])."

According to the researchers, the causes for these errors as stated in the study were, "failures in judgment (143 of 181 [79%]), vigilance or memory (106 of 181 [59%]), knowledge (86 of 181 [48%]), patient-related factors (84 of 181 [46%]), and handoffs (36 of 181 [20%])."

Dr. Tejal K. Gandhi, lead author and director of patient safety at Brigham and Women's Hospital in Boston stated that he felt doctors could use more help. He commented, "I don't want to say that it's not the physician's responsibility. We think there could be tools to help physicians make these decisions better."

At the end of the published study in the Annals of Internal Medicine, there was an editors context note that stated, "Efforts to reduce medical errors and improve patient safety have not generally addressed errors in diagnosis. As with treatment, diagnosis involves complex, fragmented processes within health care systems that are vulnerable to failures and breakdowns."