No easy cure for doc­tor er­ror

Lesotho Times - - Health -

AT­LANTA — All of us will prob­a­bly get a wrong or de­layed di­ag­no­sis at least once in our lives, some­times with “dev­as­tat­ing con­se­quences” that in­clude missed treat­ment or even death, ac­cord­ing a re­port re­leased Tues­day by the In­sti­tute of Medicine.

The re­searchers con­cluded the “inat­ten­tion” and “ne­glect” paid to these mis­takes have re­sulted in un­ac­cept­able harm to pa­tients, and they pro­jected the er­rors will prob­a­bly worsen as health care be­comes more com­plex.

“It’s prob­a­bly one of the, if not the, most un­der-rec­og­nized is­sues in pa­tient safety,” said Dr. Peter Pronovost, di­rec­tor of the Armstrong In­sti­tute for Pa­tient Safety and Qual­ity at Johns Hop­kins. “Much of the harm that we once la­beled as in­evitable we’re now see­ing as pre­ventable.”

The re­port listed sev­eral ex­am­ples of dev­as­tat­ing di­ag­nos­tic mis­takes.

A 51-year-old woman with a fam­ily history of heart dis­ease re­peat­edly asked her doc­tor’s of­fice to re­fer her to a car­di­ol­o­gist for a stress test. Three months af­ter her ini­tial re­quest, on the day of her ap­point­ment, she died be­cause of sig­nif­i­cant coro­nary artery dis­ease.

A doc­tor mis­took a blood clot in the lungs of a 33-year-old woman for an asthma at­tack, lead­ing her to her death.

An ur­gent care clin­i­cian mis­read an X-ray and di­ag­nosed a 55-yearold man with an up­per res­pi­ra­tory in­fec­tion in­stead of pneu­mo­nia. He died as a re­sult.

Doc­tors at a trauma cen­ter de­cided not to per­form a CT scan on a 21-year-old stab­bing vic­tim and missed a knife wound pen­e­trat­ing sev­eral inches into his skull and brain.

A new­born baby suf­fered pre­ventable brain dam­age when doc­tors failed to test for high lev­els of a chem­i­cal in his blood that had turned his skin yel­low from head to toe.

“It’s just in­cred­u­lous to the public,” said Pronovost, who ad­vo­cated for the study but wasn’t in­volved in it. “We just too of­ten ac­cepted bad out­comes as the norm.”

In­ad­e­quate open­ness, data

Di­ag­nos­ing pa­tients’ health prob­lems is at the core of what doc­tors and clin­i­cians do. So what leads them to some­times get things

lim­ited wrong?

The re­port iden­ti­fied a num­ber of fac­tors, from in­ad­e­quate com­mu­ni­ca­tion and col­lab­o­ra­tion to a cul­ture that dis­cour­ages dis­clo­sure of mis­takes, im­ped­ing at­tempts to learn from them.

The re­searchers ac­knowl­edged that data on di­ag­nos­tic er­rors is lim­ited. Good mea­sure­ments are hard to come by, and there’s no real con­sen­sus on what even con­sti­tutes such a mis­take. Study­ing med­i­ca­tion or sur­gi­cal er­rors or in­fec­tions that pa­tients ac­quire in­side hos­pi­tals is less of a chal­lenge.

“Frankly, this is not low-hang­ing fruit,” said Dr. Al­bert Wu, di­rec­tor of the Cen­ter for Health Ser­vices and Out­comes at Johns Hop­kins Bloomberg School of Public Health. “We tend to fo­cus on things that we can mea­sure, and this is hard to mea­sure.” Sug­gested reme­dies While Tues­day’s re­port says ur­gent change is needed, Wu says there’s no fast and easy way to fig­ure it out.

“We’re ask­ing peo­ple to man­age with­out data,” he said. “So, for ex­am­ple, I do not know what pro­por­tion of my di­ag­noses are cor­rect. There’s no feed­back mech­a­nism that I get at any point in the sys­tem about whether or not I got the most ap­pro­pri­ate test that would al­low me to make the di­ag­no­sis, and there’s no one keep­ing track of whether or not I did make the right di­ag­no­sis.”

Wu, who also wasn’t in­volved in Tues­day’s study, said it sets a course to­ward re­duc­ing the mis­takes, even though the so­lu­tions are not all clear yet.

One sig­nif­i­cant rec­om­men­da­tion in the re­port: Medi­care and or­ga­ni­za­tions that ac­credit health care or­ga­ni­za­tions should re­quire fa­cil­i­ties to mon­i­tor how they’re di­ag­nos­ing pa­tients. Right now, there is no re­quire­ment to mon­i­tor di­ag­nos­tic mishaps.

“You’d need to be spe­cific about the di­ag­no­sis you’re in­ter­ested in,” Wu said. “There’s a lot of places where this could be messy.”

Another rec­om­men­da­tion: The fed­eral gov­ern­ment should con­duct au­topsy stud­ies that es­sen­tially ask whether you died from the same thing you were be­ing treated for.

While these kinds of post­mortem ex­ams can gen­er­ate use­ful data on di­ag­nos­tic er­rors, they’ve de­clined sub­stan­tially since the 1960s, in part be­cause of cost. The av­er­age au­topsy costs about $1,275, ac­cord­ing to the re­port.

The re­port also says that doc­tors and nurses should make pa­tients feel com­fort­able about ask­ing ques­tions. Fear about be­ing a com­plainer or be­ing seen as dif­fi­cult can si­lence pa­tients and po­ten­tially lead to a bad out­come.

The re­searchers cite a study in which 87 per­cent of can­cer pa­tients didn’t re­port con­cerns that their care had been com­pro­mised.

“We need to en­cour­age pa­tients to speak up and en­sure that when they do speak up, it’s well re­ceived,” Pronovost said.

The Na­tional Pa­tient Safety Foun­da­tion and the So­ci­ety to Im­prove Di­ag­no­sis in Medicine have a check­list to help pa­tients get the right di­ag­no­sis.

“It is OK to go over the doc­tor’s head or get another opin­ion if you’re re­ally con­vinced that some­thing is be­ing missed,” Wu added. — CNN

all of us will prob­a­bly get a wrong or de­layed di­ag­no­sis at least once in our lives.

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