The most missed diagnoses by docs
The most-frequent diagnostic errors are for common conditions seen by primary care doctors, including ailments such as pneumonia and heart failure that can lead to severe harm if not treated appropriately, a study found.
The misdiagnoses occurred most often during the doctor’s examination due to trouble getting a complete history from the patient, performing the physical exam and ordering tests, according to research published today in JAMA Internal Medicine. Other common misdiagnoses were for kidney failure, urinary tract infection and cancer.
The findings show that doctors miss or wrongly diagnose a wide range of conditions that can be harmful to patients’ health, said Hardeep Singh, lead study author and chief of health policy and quality program at the Health Services Research and Development Center at the Michael E. DeBakey Veterans Affairs Medical Center in Houston. To reduce the number of misdiagnoses, more needs to be done by doctors and hospitals to engage the patient in their own health care and to improve their access to physicians, he said.
“If we do it together with patients, providers and health-care systems, we will have a much deeper impact of understanding and improving this problem,” Singh said this week.
Researchers looked at the medical records of patients at a large urban Veterans Affairs facility and a private health-care system to determine how often patients returned to doctors after a primary care visit.
Researchers focused on 190 errors in primary care visits between October 2006 and September 2007 that involved 68 unique conditions.
The most common were pneumonia at 6.7 per cent; heart failure, 5.7 per cent; kidney failure, 5.3 per cent; cancer, 5.3 per cent; and urinary tract infections, 4.8 per cent. Difficulty with diagnosing occurred not only during the initial patient exam, but with the patients, plus failure of doctors to follow up and track tests and referrals.
Better followup may help reduce errors, Singh said.
Another suggestion is to have a team-based approach in which a doctor, administrator and nurse work together to care for a patient so everyone is involved in the treatment, he said.