Also see http://www.rd.com  > HEALTH  > MISDIAGNOSED

Study Finds Basic Errors Made by Doctors Played
a Major Role in Missed or Delayed Diagnoses
10-02-2006 2:48 PM
By PATRICK WALTERS

PHILADELPHIA --  Basic errors made by doctors,
including tests ordered too late or not at all
and failure to create follow-up plans, played
a role in nearly 60 percent of cases in which
patients were allegedly hurt by missed or
delayed diagnoses, a study found.
Researchers in the study, published in the
Annals of Internal Medicine on Monday, reviewed
307 closed medical malpractice claims, 181 of
which allegedly involved diagnostic errors that
ended up harming patients. A large majority of
those cases involved various types of cancer.
While researchers acknowledged that most claims
involved several factors, they said major ones
included mistakes by doctors: failure to order
appropriate diagnostic tests (100 cases);
failure to create a proper follow-up plan (81);
failure to obtain an adequate history or perform
an adequate physical examination (76); and
incorrect interpretation of tests (67).
Doctors not involved with the study said the
findings highlight the fact that physicians _
and patients_ need to err on the side of caution
when it comes to ordering diagnostic tests,
keeping detailed records and doing follow-up.
"It seemed like the bottom line was that the
problems were problems that would occur less
if a person was just very compulsive or very
diligent," said Dr. Steven Sorscher, an
oncologist at Washington University Medical
School in St. Louis. "It highlights the fact
that the causes of serious errors are often
preventable."
The study's lead author, Dr. Tejal K. Gandhi,
director of patient safety at Brigham and
Women's Hospital in Boston, said the research
shows that doctors could use more help in making
decisions. Things that could help include more
use of electronic records, better algorithms for
making evaluations and the use of nurse
practitioners to help ensure that follow-ups
actually occur, she said.
"I don't want to say that it's not the
physician's responsibility," Gandhi said. "We
think there could be tools to help physicians
make these decisions better."
The study looked at random samples of claims
from four malpractice insurance companies
throughout the U.S. The reviewers were
instructed to ignore the outcomes of the claims,
all of which closed between 1984 and 2004;
nearly 60 percent of the cases resulted in
serious harm and 30 percent resulted in death.
All involved missed or delayed diagnoses in
office settings.
Most of the errors occurred in doctor's offices
and primary care physicians were those most
frequently involved. More than half of the
missed diagnoses involved cancer, primarily
breast and colorectal cancer, and biopsies were
the test most frequently at issue.
The researchers said the leading factors that
contributed to errors included failures in
judgment (79 percent), vigilance or memory (59
percent), knowledge (48 percent),
patient-related factors (46 percent) and
handoffs (20 percent).
Dr. Edward Langston, chair-elect of the board of
the American Medical Association, said doctors
have become more aggressive in recent years as
far as ordering tests such as biopsies and
colonoscopies. They also do more screens even
when the patient shows no symptoms, he said.
But the study also showed the importance of
patients paying close attention to their care,
voicing their opinions and bringing loved ones
with them to appointments to help process
information and ask questions, he said.
"Communication issues are major issues," said
Langston, a primary-care doctor in Lafayette,
Ind. "The message is we need to take a hard look
at what's happening and how can we decrease it."
__
On the Net:
Annals of Internal Medicine:
http://www.annals.org/
American Medical Association:
http://www.ama-assn.org/

... The first step is to say nice things about myself.
... The second, to do nice things for myself.
... The third, to find someone to buy me nice things.
___ Blue Wave/QWK v2.12