On April 29, the New York Times health blog Well published a post titled, “Why Doctors Are Sued.” In its first sentence, it promises to reveal the answer to the question: “What kind of medical error accounts for most malpractice payments?” The answer, its author tells us, is not surgical mistakes, nor is it medication errors, nor problems during birth. It is errors in diagnosis: both failure to identify and treat a medical problem (failed diagnosis) and incorrectly diagnosing symptoms as something they are not (misdiagnosis).
These findings came in a study published in the British Medical Journal. A team of researchers at Johns Hopkins combed through data from about 350,000 cases in the National Practitioner Data Bank and established that 28.6 percent of medical malpractice payments–more than 100,000 in all–resulted from mistakes in diagnosis. This type of error was also responsible for 33.8 percent of disabilities and 40 percent of deaths that occurred in cases that resulted in malpractice payments. The team studied data collected from 1986 to 2010 and also found that general treatment errors were the second most common; surgical errors came in third. The blog reports “all other errors combined–obstetric, medication, monitoring, anesthesia, and the rest–accounted for only 20 percent of malpractice payments.”
The senior author of the study, Dr. David Newman-Toker, claims that this is a “major” problem, and that part of the issue is that none of the groups involved–“physicians, hospitals, and insurers”–can agree on whom to hold accountable. “There is no institute that views it as their problem,” he complains, adding, “there’s no public reporting requirements for measuring diagnostic accuracy or error.”
The Washington Post goes deeper into these figures and claims that 10 to 20 percent of deaths result from issues not diagnosed when the patient was living and that “40,000 to 80,000 Americans die from missed diagnoses each year.” This article also adds that the average payment in successful obstetrical cases was nearly $700,000, while diagnostic claims averaged $389,000. This also helps to refute the existence of so-called “jackpot justice” in our civil justice system, along with claims that multi-million dollar results run rampant.
The study does not attempt to ascertain exactly why missed or failed diagnoses are so prominent on this list, and Dr. Newman-Toker can only offer, “Diagnosis is hard. It’s complicated. It happens under quite a lot of uncertainty and time pressure.” It is disappointing that, in a health care system as expensive as ours, so many mistakes are being made before even the time of treatment, and the author adds, “you can’t get the treatment right if you don’t get the diagnosis right.”