Medical Misdiagnosis and “The Big Three”

A study from the Johns Hopkins University School of Medicine has identified the three major disease categories most misdiagnosed by medical professionals in the United States. These conditions, known as the Big Three, are responsible for nearly two-thirds of injuries from diagnostic errors. A diagnostic error, or misdiagnosis, can mean the difference between life and death for a patient – delays in treatment or improper treatment can cause permanent injury or loss of life.

The research, published last year in the Diagnosis medical journal, was a joint effort between Baltimore-based Johns Hopkins and data analytics firm CRICO Strategies. They based their analysis on data culled from high-quality US-based studies, as well as a repository of medical malpractice claims, assessing rates of diagnostic errors and the effects of those errors on patients.

About diagnostic errors

Diagnostic errors are not only one of the most important safety issues in healthcare today, they are also errors that can inflict the most harm upon a patient. According to the Society to Improve Diagnosis in Medicine, major diagnostic errors have been found in to 10 to 20 percent of autopsies, which suggests that 40,000 to 80,000 patients die each year from diagnostic mistakes.

They also report that “at least one person in three has firsthand experience with a diagnostic error, and researchers have found that diagnostic errors—not surgical mistakes, or medication overdoses—account for the largest fraction of malpractice claims, the most severe patient harm, and the highest total of penalty payouts.”

The Big Three

The Johns Hopkins research team found diagnostic errors occur most often in three major categories: vascular events (like heart attack and stroke), infections, and cancers. These conditions account for almost 75 percent of all serious harms from misdiagnosis or diagnostic errors. Team leader David Newman-Toker, Director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence, remarked, “Our findings suggest that the most serious harms can be attributed to a surprisingly small number of conditions. It still won’t be an easy or quick fix, but that gives us both a place to start and real hope that the problem is fixable.”

Diagnostic errors for the Big Three broke down as follows:

• Cancers – 37.8%
• Vascular events – 22.8%
• Infections – 13.5%

Researchers noted that these errors led to death or serious and permanent disability. According to Johns Hopkins, “the top conditions in each category are stroke, sepsis and lung cancer, respectively. These are accompanied by heart attack, venous thromboembolism, aortic aneurysm and dissection, arterial thromboembolism, meningitis and encephalitis, spinal infection, pneumonia, endocarditis, and breast, colorectal, prostate and skin cancers.”

Overall, researchers concluded that about one in every 10 patients with symptoms of the Big Three experienced a misdiagnosis, and that about one in 20 of those patients will suffer serious injury.

Are there different kinds of diagnostic errors?

Yes. A doctor, nurse, tech, or other medical professional can make different types of diagnostic errors, including:

• Delayed diagnosis. This is when there is a significant delay before the correct diagnosis is made.
• Failure to diagnose a related disease. When a doctor correctly diagnoses a condition, but misses a second related condition.
• Failure to diagnose an unrelated disease. When a doctor correctly diagnoses a condition, but misses a second, unrelated condition.
• Failure to recognize complications. When a doctor correctly diagnoses a condition, but misses related complications.
• Misdiagnosis. Also called wrong diagnosis, this happens when a doctor diagnoses a patient with the wrong illness and treats them for the wrong illness.
• Missed diagnosis. This happens when a doctor misses a condition or disease completely and gives a patient a clean bill of health.

Experienced malpractice attorneys can investigate where your misdiagnosis went wrong and hold the right people accountable for your injuries.

Why do diagnostic errors happen?

Failure to diagnose is a form of medical malpractice that occurs when a doctor or other healthcare professional delays or fails to diagnose a serious condition or illness in a patient, where in similar circumstances another reasonable professional would have diagnosed them earlier. There can be many reasons for a diagnostic error, including the following:

• Errors in reading test results
• Failure to differentiate between medical conditions with similar symptoms
• Failure to order tests
• Failure to recognize symptoms
• Failure to refer patient to specialist
• Human error and confirmation bias
• Improper labeling of lab samples
• Lack of attention to patient symptoms and health history
• Radiology or pathology misreads

Human error tends to be one of the biggest causes of misdiagnosis and medical error. When a medical professional is looking for evidence of what they think is wrong (for example, looking for evidence of heartburn when a patient is actually experiencing a cardiac event), they can miss other evidence of the actual condition. Doctors must look at all the information, and not just what they believe is important.

Minimizing the risk of medical misdiagnosis

Health online offers some advice from experts on how you can lessen the potential of medical misdiagnosis and advocate for yourself or your loved ones. However, this cannot be all on the patient. As Health says, “Accurately diagnosing vascular events, infections, and cancers will require a multifaceted approach. There needs to be greater teamwork and training, better use of technology, and feedback to help clinicians fine-tune their efforts.”

In the meantime, patients can help by:

• Come to the doctor prepared for your visit. Have a summary of your problem ready, with a focus on your symptoms in the order they happened.
• Ask your doctor, “What’s the worst thing you think this could be?” Then ask them why they think it’s not. If they can’t give you a clear and concise answer, think about a second opinion.
• Stay vigilant. If it seems your treatment isn’t working, ask why. Are you getting the right treatment for the wrong condition? Or the wrong treatment for the right condition? Talk to your doctors whenever you feel something isn’t quite right.
• Document everything – save all your x-rays, CT scans, and test results.

The best chance for a successful personal injury case is having as much evidence and documentation as possible.

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