Is Misdiagnosis Inevitable?

Leigh Page

Disclosures

March 28, 2016

In This Article

Can Misdiagnoses Be Prevented?

Experts are still debating the actual number of misdiagnoses, and how many of them can actually be prevented. The IOM report cites a 2014 observational study[5] estimating that 5% of US adults, or 12 million patients a year, are misdiagnosed. Many of these errors are thought to be relatively harmless, but some of them lead to serious complications and death.

One study[6] estimates that 80,000-160,000 patients a year are affected by serious misdiagnoses, such as failing to diagnose a heart attack, stroke, or cancer, whereas another study[7] estimated that about 40,000-80,000 patients a year die of misdiagnoses.

Physicians tend to estimate lower misdiagnosis rates. A 2011 survey[8] on diagnostic errors by QuantiaMD, collaborating with Dr Wachter, polled more than 6400 clinicians—almost three quarters of whom were physicians. Only about one half said that they came across a misdiagnoses at least once a month in their healthcare setting – a much lower rate than 5% of all diagnoses, and more in line with estimates of serious misdiagnoses.

Furthermore, the clinicians were skeptical that many misdiagnoses could be prevented. Whereas almost 90% agreed that errors were "sometimes" preventable, only 8% said they were "always" preventable. They were also skeptical that a protracted campaign could lower misdiagnoses: Sixteen percent were very confident that errors would fall, 67% were only somewhat confident, and 17% were not confident.

This skepticism may have to do with how these clinicians saw misdiagnoses coming about. Three quarters cited "atypical patient presentation," which cannot be addressed by improving' one's diagnostic reasoning.

In the QuantiaMD survey, one half of respondents said that one of the top causes of misdiagnoses was "failure to consider other diagnoses," which might be addressed by improving one's diagnostic reasoning, but three quarters cited "atypical patient presentation."

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