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July 29, 2019

The 'Big Three' medical conditions most likely to be misdiagnosed, according to 55K+ malpractice claims

Daily Briefing

    Diagnostic errors for cancers, infections, and vascular events accounted for more than 60% of medical malpractice claims over a 10-year period, according to a study published this month in the journal Diagnosis.

    One key to improving your hospital's quality: Identify clinical variation


    To determine the extent of harm caused by diagnostic errors, a group of Johns Hopkins University researchers reviewed 55,377 closed malpractice claims spanning 2006 to 2015. The data, which came from the Controlled Risk Insurance Company's Comparative Benchmarking System database, represent about 29% of all malpractice claims in the United States during the 10-year period.

    The study also analyzed the number of claims associated with specific diseases, focusing on what the researchers called the "Big Three":

    • Cancer;
    • Vascular events; and
    • Infection.


    The researchers found that 11,592 claims, or 21% of the malpractice claims examined, were related to diagnostic errors, including 7,379 that involved serious harm, such as permanent disability or death.

    The researchers found that patients with the "Big Three" conditions accounted for 61.7% of the diagnostic error claims examined, and 74.1% of those claims led to severe harm. Broken down by disease type, the researchers found cancers accounted for 37.8% of the severe misdiagnosis errors, while vascular issues accounted for 22.8% and infections accounted for 13.5%.

    When the researchers examined the top five subconditions within each of the "Big Three" conditions, they found stroke, lung cancer, and sepsis resulted in the most serious harm.

    The researchers' also determined that the cause of most misdiagnoses was clinical judgment failure.

    Based on the findings, the researchers estimated that misdiagnoses could cause between 40,000 and 80,000 deaths in U.S. hospitals each year and about 80,000-160,000 serious cases of harm.


    The study's results highlight the role diagnostic errors play in patient harms, according to David Newman-Toker, lead author of the study and director of the Center for Diagnostic Excellence at Johns Hopkins Armstrong Institute for Patient Safety and Quality.

    "Diagnostic errors are the most common, most catastrophic, and most costly medical errors both for society and for individual patients," he said. Newman-Toker added, "It's not just inconvenient to have a wrong or delayed diagnosis. For many patients, misdiagnosis causes severe harm and expense, and in the worst cases, death."

    Paul Epner, CEO and co-founder of the Society to Improve Diagnosis in Medicine, said the study's insights on the role of the "Big Three" conditions will give researchers a place to start to find ways to improve patient care.  

    "What [the data on the 'Big Three'] suggests to us … is we might be able to take a big chunk out of this problem and save a lot of lives and prevent a lot of disability if we focus energy on tackling these problems," Newman-Toker said, adding, "At least it gives us a roadmap and a starting. ... It really wasn't known prior to this study."

    In addition, the researchers said the findings on clinical judgement failures suggest "it will be necessary to develop systems solutions to solve cognitive problems (e.g., device-based decision support, simulation to improve medical education, diagnostic performance dashboards, or access to specialists via tele-consultation)."

    Helen Burstin, executive vice president and CEO of the Council of Medical Specialty Societies, said doctors should not bear sole responsibility for the problem of misdiagnosis. "We have to acknowledge the complexity of this issue," she said, adding, "This is not the time for clinician-blaming. … [W]e need to put the right resources into making this better" (Castellucci, Modern Healthcare, 7/11; Tucker, Medscape, 7/12; Frieden, MedPage Today, 7/12; Sharkey, Medical News Today, 7/22).

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