Study Finds Diagnostic Mistakes a Big Contributor to Malpractice Suits
Diagnostic errors are more than just a danger to patients or an ethical issue, they can also present a liability issue for physicians. Dana Siegal, RN, discussed this data as well as ways for the healthcare industry to evolve at the 2021 Working Together to Improve Diagnosis virtual conference hosted by the Iowa Healthcare Collaborative.
Data and Diagnostic Error Cases
During the conference, Siegal shared national Medical Professional Liability, MPL, claims data that illustrated the challenges in diagnostic error cases. The claims came from the databases of more than 20 captive and commercial liability insurers from 2014-2018, performed by CIRCO Strategies, a medical liability insurer.
The study examined 50,328 closed cases and found that the diagnosis-related cases had an average gross indemnity payment of around $494,000 reported Siegal. This payment was second only to ob/gyn-related cases, which had an average payment of $902,000.
Although diagnosis-related cases had a lower average payment, they had a higher total payout: $1.74 billion as compared to $838 million for ob/gyn cases. Siegal also reported that the number of diagnosis-related cases was also higher, at 8,922 cases compared with 2,053 ob/gyn cases. Of the diagnosis-related cases, 39% were closed with an indemnity payment, second only to ob/gyn cases, at 45%.
86% of the malpractice cases that surrounded a wrong diagnosis involved a challenge around critical judgment. In addition, of the diagnosis-related cases, Siegal found that in 37% of these cases, there was an error surrounding a diagnostic test. These errors in diagnostic tests included failure or delay in ordering a test or administering a test that appeared to be relevant at the moment but was actually unnecessary.
In addition, 36% of malpractice cases involved the failure to appreciate and reconcile a relevant sign, symptom or test result.
Testing and test processing are also an issue in many medical malpractice cases. However, the study found that getting test results to a provider is rarely the cause. Of the cases studied, only 5% were impacted by a test result that did not reach the provider.
However, 23% of them were impacted when the physician missed following up with the patient properly. “While we often think it’s missing test results, really the communication between the provider and the patient becomes a primary focus of vulnerability, as does the communication for the referral process,” said Siegal.
Analysis of Diagnostic Errors
Siegal believes that analysis of these diagnostic errors can help to better the medical field. “We make errors for a reason, and my job is focused solely on trying to understand the reasons behind the error,” said Seigal. “Many of them are pretty visible.”
In the instance of an error in clinical judgement, Siegal hopes to use the data from the study to influence practices going forward. “We have an opportunity to look back at how many times a particular test– sitting or living in a particular kind of setting, scenario, or set of symptoms– may be beneficial,” said Siegal. “If we raise awareness on that, if we focus on that, we might be able to change the story going forward.”
According to Siegal, one problem that leads to the amount of diagnostic mistakes is the inherent risk of the healthcare industry. “There is ever-changing industry knowledge, growing bodies of clinical options, new diseases, and new technology,” noted Siegal. Siegal also referenced variable individual competence, an aging population, complex health issues and evolving workforces as factors that have influenced diagnostic error cases.
Evolution in Diagnostic Practices
Siegal reflected on a recent wrong-site surgery case in which a man in Austria had the incorrect leg amputated. She hopes that the healthcare industry can use past misdiagnosis cases to remap the future of medical practices. “If we don’t study what’s available to us from the past, we’re not going to be able to impact the future,” noted Siegal.
Siegal referenced the investigations that are often done in many other occupational accidents, such as airline crashes and industrial accidents. She believed that a similar practice should be adopted into healthcare.
In addition to reflecting on historical data, Siegal also urged colleagues to consider adapting their current diagnostic practices. Cognitive biases, such as anchor bias and confirmation bias, can often negatively affect a diagnosis.
Anchor bias occurs during the diagnostic process when a physician anchors onto a diagnosis early on and then looks for things to confirm that diagnosis. Once a physician has confirmed their diagnosis enough so that search satisfaction is met, a patient’s case is closed- potentially prematurely.
Confirmation bias occurs when a physician only looks at signs or symptoms that confirms what they knew. This bias often leaves other present signs, symptoms and test results ignored if they don’t fit into the assumed diagnosis.
Siegal suggested that clinicians take a diagnostic timeout, similar to a surgical timeout, when arriving at a diagnosis. “What else could this be? Have I truly explored all other possibilities that seem relevant in this scenario and, more importantly, what doesn’t fit? Be sure to dis-confirm as well,” urged Siegal.
During the conference, Siegal pointed out the objectivity of the study. “Please understand that as we look at the data, we fully recognize that this is hindsight, and by the time we receive it, we have the entire journey,” said Siegal. “This is not meant to be an edict or a judgement that the provider failed, or that the team failed.”
By revolutionizing diagnostic practices, physicians have the ability to correct diagnostic errors, ultimately reducing their liability. Through analysis as well as adaptation of current practices, there is potential to protect both patients and doctors.
The Baltimore Attorneys at Peter Angelos Law Fight for Victims of Medical Malpractice
Diagnostic errors including misdiagnosis, failure to consider all possible diagnoses, failure or delay in ordering a test and administering the wrong treatments can all be detrimental to a patient. If you or someone you love was a victim of a medical error, do not hesitate to reach out to the medical malpractice attorneys at Peter Angelos Law today. To learn more about the work we do as Baltimore medical malpractice attorneys or to discuss your case, call us today at 1-800-556-5522 or fill out the contact sheet below.