Misdiagnosis: Millions of patients are being treated for the wrong conditions
Despite expensive new technologies, millions of patients worldwide are being treated for the wrong conditions, writes Evan Falchuk, vice chairman of Best Doctors, Inc., in Boston. Misdiagnosis means needless suffering and hundreds of millions of dollars wasted each year.
Special to The Times
WE read and hear a lot of headlines about health-care reform and related costs and hurdles. What we hear a lot less of, though, is misdiagnosis and why correcting the situation should be made a priority.
Despite our "latest and greatest" technologies, 15 percent of all medical cases in developed countries are misdiagnosed, according to The American Journal of Medicine. Literally millions of patients worldwide are being treated for the wrong conditions every year. The Mayo Clinic Proceedings found that 26 percent of cases were misdiagnosed while, according to The Journal of Clinical Oncology, up to a startling 44 percent of some types of cancer are misdiagnosed.
These statistics should be getting a lot more attention.
Misdiagnosis means needless suffering for patients and their families, and in many cases, even lost lives. Secondarily, it also means nearly one-third of the $2.7 trillion spent each year on health care in the U.S. are considered to be wasted dollars.
So how can this still be occurring so regularly, and why have misdiagnosis rates not changed much over the past 30 years?
I believe five root causes explain the situation.
First, our health-care system is greatly fragmented. When there are so many opportunities to delay or misread tests, miscommunicate findings or order the wrong tests in the first place, the odds of getting the right diagnosis and right treatment too often are stacked against the patient.
A second root cause, according to Dr. Eta S. Berner and Dr. Mark L. Graber's compelling article "Diagnostic Error: Is Overconfidence the Problem?", may well be a physician's overconfidence in his or her diagnostic ability. Once doctors have made up their mind about a patient's condition, and once a diagnosis has been reached and the patient is sent down a treatment path, it's very, very hard to step off that path.
This leads to the third root cause of misdiagnosis, which stems from the way doctors are trained to think. Dr. Jerome Groopman, one of the world's foremost thinkers on diagnostic error, believes today's "rigid reliance on evidence-based medicine" (reaching treatment decisions based on statistically proven data) is largely to blame for many diagnoses that are missed or off the mark.
The fourth root cause boils down to time, or lack thereof. Many time-strapped doctors today typically spend 10 to 15 minutes or less with each patient — not because they don't care, but because there simply are not enough hours in the day to meet demand for in-depth, more detail-oriented care.
The fifth root cause of misdiagnosis is the still-growing number of subspecialty areas in which physicians practice. Whereas in earlier years doctors might specialize in one certain type of cancer, a growing number of them now choose to focus on the subset of a subcategory of a particular type of cancer. This is less than ideal if your initial treating doctor lacks in-depth training in the exact type of illness you have.
So what can be done to reverse course and shrink misdiagnosis rates to something closer to zero?
Raising awareness of the issue and its causes among physicians is sorely needed, as well as more in-depth exams and data analysis, to include such vital factors as carefully examining a patient's complete, detailed medical history.
Teaching medical students in a way that doesn't always center on looking for the quickest, easiest diagnosis could mean better diagnoses for millions of people every year. Medical students are trained that "when you hear hoof beats, think horses, not zebras." This cognitive shortcut generally works well, but combined with the pressured reality of modern medical practice, it impacts a doctor's capacity for critical thinking.
In today's system, doctors easily see a hundred or more patients a week, and often spend scant minutes with each — nowhere near the time needed to examine all medical possibilities and important related factors like a patient's full family medical history. With even an additional 10 minutes with patients, diagnoses would have much less of a "best guess" approach. And if hospitals and doctors would track instances of misdiagnosis — and give their colleagues regular feedback on misdiagnosed cases — the impact would be substantial.
By starting to really press the discussion of medical quality in this direction, doctors, the people at the front lines of the battle for better patient care — as well as their patients — can start to make an enormous difference.Evan Falchuk is vice chairman of Best Doctors, Inc., a global health company based in Boston. He is an active member of the National Business Group on Health's "National Leadership Committee on Consumerism and Engagement," the National Governors Association and the American Benefits Council.