Misdiagnosis causes 800,000 deaths and severe disabilities each year in the U.S.

D.diagnostic error In other words, overlooking, misdiagnosing, or delaying diagnosis is well known in medical practice and can have tragic consequences. But so far, there have been few attempts to quantify misdiagnosis in terms of mortality or permanent disability, and the full impact is underestimated by the medical community, according to a 2015 report from the medical community. National Academy of Medicine.

new research published BMJ of the Week, which finally addresses that gap.Estimate Each year, 371,000 people die from misdiagnosis, 424,000 are permanently disabled, and a total of 800,000 suffer “severe harm,” said lead author David Newman Toker, professor of neurology at Johns Hopkins University School of Medicine. and Director of the Diagnostic Center of Excellence. S.He said it’s difficult to get an exact figure because the diagnosis often goes undetected.It may be less than identified in his study, or it may be more (between 500,000 and 1 million), but in any case, it is most common cause Death or disability due to medical malpractice.

He likened the misdiagnosis problem to an iceberg, saying cases leading to death and disability were only a small part of the problem. “We’ve focused on serious harm here, but the number of diagnostic errors that occur each year in the United States is probably 50 million to 100 million,” he said. “When you actually look at it, you can see that it’s happening all the time.”

However, in most cases, people do not see a doctor with serious symptoms, so a misdiagnosis does not have serious consequences. “The level of risk that something terrible will happen because of a misdiagnosis just by walking through the door of the doctor’s office is actually pretty low,” Newman-Toker said.

But the situation is different for the minority of people who come to the clinic with severe, potentially fatal symptoms. For example, people who experienced dizziness after having a stroke but were diagnosed with dizziness instead, or young women whose breast cancer was missed during routine check-ups. For them, the study found a 4% risk of misdiagnosis-related death and an 11% risk of severe disability.

Affordable Solutions

Analyzing the nature of misdiagnosis also provides important opportunities for solutions. The misdiagnosis is numerous, but quite concentrated. According to the study, 15 diseases accounted for about half of the misdiagnoses, and five diseases alone—stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer—caused 300,000 serious harms, or about 40% of the total, because clinicians failed to identify patient misdiagnoses. “If he can reduce the suffering of just five diseases by 50%, this will accomplish a lot. This will prevent 150,000 people from severe permanent disability or death,” Newman Toker said.

A major cause of misdiagnosis is cognitive error It’s also on the doctor’s side, he said. Doctors may make an incorrect diagnosis because the signs of the disorder are not typical or because the symptoms are too common and not often associated with a serious disorder. For example, dizziness occurs in most cases of stroke, but only a few cases cause dizziness.

Alternatively, it could be a matter of situational bias. For example, overlooking the possibility that a young patient has a stroke because it is so rare. or systemicfor example symptom relief reported by a black patient. (Newman Toker says his own research estimates that being a woman or a person of color increases the chance of being misdiagnosed by 20% to 30%.)

This means that many lives could be saved if we could find ways to circumvent such cognitive errors, at least in the most commonly misdiagnosed serious diseases. What’s the easy way? Newman-Toker suggests getting regular second opinions during visits. “I believe the fastest way to solve the problem of diagnostic errors in the real world is to build an approach that basically relies on a ‘call a friend’ model,” he said. This does not mean that patients should seek a second opinion, but rather that providers should make it standard to consult colleagues before making a diagnosis or dismissing a patient.

financial burden

The study results also provide insight into the economic burden of misdiagnosis, which has been difficult to quantify due to the lack of reliable estimates of incidence.

William Padula, an assistant professor of medicine and health economics at the University of Southern California, who was not involved in the study, also cites stroke as an example to illustrate the enormous cost of misdiagnosis. It is the most commonly misdiagnosed serious illness, AI is I tested it as a solution.

“Patients come to the emergency department complaining of headaches and dizziness, go home told they will be fine soon, and a week later find out they have had a stroke,” he said. “By that time, the stroke had gotten so bad that the only thing I could have dealt with at that moment was […] A $10,000 problem becomes a $100,000 problem. […] That means a $90,000 leeway in the cost of the U.S. health care system due to misdiagnosis. ”

Multiply that by the hundreds of thousands of misdiagnoses, and the total cost is likely to be prohibitive, on the order of $100 billion and possibly even billions more, especially considering social costs such as premature death and years of lost productivity due to disability, Padura said. “On the one hand, having an accurate diagnosis could potentially save more than $100 billion. And on the back end, if we get this problem right, it could be $24 trillion in GDP instead of $22 trillion, just by making sure everyone gets the care they need,” he said.

This helps put the costs into perspective of getting a second opinion or adding additional tests to rule out certain symptoms. “Spending extra money up front to diagnose patients more accurately is a cost-effective solution,” Padura said.

But funding for research to improve diagnostics is very limited, and commensurately insufficient political (and medical) importance to the issue, Newman-Toker said.

“The amount of federal research funding to address this issue is on the order of $20 million to $30 million annually,” he said. Prior to 2016, federal funding was even lower, at $7 million a year, but increased as more data became available about the impact of misdiagnosis, he said. That’s about $50 per death, he said, but it’s paltry considering federal investment in research into cures for some serious diseases, such as certain types of cancer, can reach $400,000 per recorded death from the disease.

As a comparison, Newman Toker I got it $39 million Goes to study smallpox. “It’s certainly an important study, but smallpox was eradicated 50 years ago with zero deaths,” he said.