Encouraging News in Efforts to Prevent Diagnostic Errors

According to Laura Landro of the Wall Street Journal’s Health Blog, diagnostic mistakes are the Achilles’ heel of medicine, yet little has been done to prevent their deadly toll.

With the growing concern over the costly medical malpractice claims from mistaken diagnosis, two of the United States biggest health-care providers, the Veterans Administration and Kaiser Permanente, are spearheading the attempts to improve diagnostic accuracy.  According to Laura Landro, the VA and Kaiser are embarking on initiatives aimed at the most common lapses in the diagnostic process, such as failure to order the right tests, create proper follow-up plans, obtain complete medical histories or perform adequate physical exams.

Laura Landro reports that Kaiser and the VA are using a variety of new tools, including Web-based “decision support” programs to assist doctors by offering an array of possible diagnoses they might not have considered or prompting them to perform appropriate tests on patient with certain symptoms. Jason Maude co-developed one such system, known as Isabel (isabelhealthcare.com). Jason Maude is the former head of equity research at a financial-services firm. According to the Wall Street Journal Health Blog, Jason Maude developed this system after his daughter, Isabel, had a serious infection that went undiagnosed.

The Wall Street Journal Health Blog states that Kaiser and the VA are pilot-testing the Isabel system, which is already in use by a small but growing number of doctors’ offices, hospitals, and medical-information companies across the globe.  After a patient’s symptoms are entered into a computer, the Isabel program usually presents 10 diagnoses on the first Web page, and an additional five to10 on subsequent pages, up to a total of 30, in no particular order.

Mark Graber, the chief of medical services at the VA Medical Center in Northport, N.Y., has discovered that the Isabel program suggested the correct diagnosis in 98% of the cases, the Wall Street Journal Health Blog reports. Dr. Graber states that decision-support systems can help doctors avoid the medical diagnostic mistake of “premature closure”, which is the tendency to focus on one medical diagnosis that appears to explain all of the symptoms, then stop considering other possibilities, according to the Health Blog.

Studies show that diagnostic errors occur in 10% to 30% of cases, and generally arise from errors in doctors’ thinking, glitches in the health-care system, or some combination of the two. The Wall Street Journal reports that while many diagnostic errors do not result in serious injury, diagnostic errors that potentially could have changed a patient’s outcome are found in 5% to 10% of all autopsies, according to a 2002 study funded by the Agency for Healthcare Research and Quality.

According to the Wall Street Journal’s Health Blog, diagnostic errors are among the largest causes of paid medical malpractice claims at Kaiser and the VA, but studies show an industry wide problem.  A study of 300 closed medical malpractice claims published in the Annals of Internal Medicine found that 59% involved diagnostic errors that seriously injured patients and 30% resulted in death.

The Wall Street Journal’s Laura Landro reports that the closed medical malpractice-claims dockets are filled with horror stories, including the story of a 56-year-old California real-estate broker who suffered brain damage and had to have both legs amputated below the knees after emergency room doctors misdiagnosed his aortic dissection as angina, delaying treatment of this surgical emergency.  The Health Blog states that colon and breast cancers are among the most frequently misdiagnosed or overlooked, leading to shortened life spans and premature deaths.

According to the WSJ’s blog article, Dr. Graber, who is also associate chairman of the department of medicine at the affiliated State University of New York at Stony Brook, states that misdiagnosis errors have “barely been on the radar screen,” compared with more obvious errors such as wrong-site surgeries.  The Wall Street Journal reports that Dr. Graber is one of several VA experts looking for ways to reduce diagnostic errors by ensuring critical test results reach the correct doctor and are acted upon in a timely manner.

The WSJ reports that with more than 10,000 known medical conditions and symptoms that are often hard to distinguish, doctors frequently cannot synthesize everything they need to accurately diagnose the correct condition.  Because medical doctors are not usually challenged by their patients, peers or subordinates, they can develop a dangerous combination of “overconfidence and complacency,” says Dr. Graber, who has hosted a meeting in Naples, Florida, with other experts to explore how to raise awareness of the problem with doctors.

The blog states that failure to diagnose often happens when patients see several different health-care providers who don’t communicate. Failure to diagnose also happens when patients’ complaints are not taken seriously – such as a patient who shows up with chest pains but doctors don’t test for cardiac disease.  In analyzing the diagnostic process recently, Kaiser found that doctors sometimes did not correctly interpret a patient’s symptoms, such as a nursing mother whose breast lump is dismissed as a clogged milk duct from a breast pump – and turned up nine months later with a four-centimeter breast mass.

According to Laura Landro, adding the Isabel system would cost about $180 per bed per year for a hospital, which equals approximately $54,000 a year for an average 300-bed hospital, and $500 a year for individual physicians and group practices.  Doctors who have employed the Isabel system at hospitals around the country report that it especially helps in teaching medical residents.

The WSJ article states that, when making rounds with residents of children with “tricky symptoms,” Richard Chinnock, chairman of pediatrics at the Loma Linda Children’s Hospital in Loma Linda, California, says he asks his residents, “Did you guys Isabel this?  Are you comfortable you thought of everything?”  At Yale University’s Yale-New Haven Children’s Hospital, physician in chief Margaret K. Hostetter states that the Isabel system is employed “to get residents to broaden their thinking” and to consider such issues as whether a child with a fever and rash should be evaluated not only for infections but also for juvenile rheumatoid arthritis or lupus.

The Wall Street Journal quotes Stephen Borowitz, a specialist in pediatric gastroenterology at the University of Virginia Children’s Hospital, and another Isabel user. According to Dr. Borowitz, “This is really a culture change for doctors. We have to face that we can’t really know it all or carry all the medical knowledge in our heads.”

Kaiser is also testing a diagnostic aid for the emergency department called the Emergency Medicine Risk Initiative as part of its new electronic-medical record system according to the Wall Street Journal. The diagnostic aid is designed by Chicago area patient-safety and risk management concern called the Sullivan Group.  Laura Landro’s blogs that the Web-based tool prompts physicians and nurses to ask for a series of questions, order certain tests and record their actions on a chart for patients that present with high-risk symptoms such as chest pain, shortness of breath and childhood fevers that could be signs of serious illness but are often misdiagnosed.  The prompts make sure that medical professionals consider rare conditions, but also makes them document in an electronic medical record or paper chart that they have covered all the bases by checking off their steps. Even though the program can be cumbersome and time-consuming, it can help prevent fatal medical malpractice errors.

Boyd B. Newton PC, an Atlanta Medical Malpractice Attorney, has handled numerous cases concerning medical misdiagnosis.  If you or someone you love has been injured from the negligence of a healthcare provider, contact us at 404-593-2630 or click the following link http://www.injurylawyerofatlanta.com/contact-us/.

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