Misdiagnosis: Where the System Fails Physicians
According to a 2013 study in BMJ Quality and Safety, it is tough to get accurate numbers about misdiagnosis, though it is estimated to be somewhere between 5-10% of all cases. Yet, despite this startling statistic, a recent article in The New York Times points out that most efforts to address errors in medicine have not focused on misdiagnosis, but instead, on errors in treatment, until now.
The Institute of Medicine just released their new report, Improving Diagnosis in Health Care, and it is a welcomed bit of research. According to another BMJ Quality and Safety study, errors in diagnosis can potentially be more deadly than errors in treatment. The IOM report states that nearly everyone will face a misdiagnosis at some point in their lives.
The IOM report does not simply blame physicians for errors in diagnosis. Instead, it lays most of the blame on our health care system –a system that provides no incentive to thoroughly think about cases, or to collaborate with colleagues to discuss them, or to spend extra time with patients to possibly uncover additional, critical information. The current health care reimbursement system favors procedures over talk and thinking. The New York Times article goes through several examples of how this system fails its physician-author. That’s not to say that physicians only care about money and reimbursement, but they do have to care about productivity and get through the day’s workload. And, if more time is taken to diagnose a patient by spending more time with them or discussing their case with a colleague, and it isn’t going to be reimbursed, it just makes an already long day, longer, and less efficient. The author muses how it’s often easier to order the MRI.
To the IOM’s credit, in their report they press insurance companies to start reimbursing for the cognitive practice of medicine, and to thus eliminate the incentive to order the procedure. And, this is great because not only would this lead to better medicine, but it would also reduce needless services.
Finally, interestingly, the IOM report also points out that many physicians aren’t even aware of the number of times they’ve made a misdiagnosis, because often, patients are referred to other physicians and/or don’t follow-up with them. Quite simply, they rarely know the outcomes of their cases. The report goes on to recommend a follow-up and feedback process for physicians so they can learn of and from misdiagnoses and near-misses.