A medical diagnostic error is a failure of a medical professional to correctly diagnose a patient’s health problem in a clear and timely manner. Unfortunately, medical diagnostic errors occur very frequently and can have severe health and financial consequences. These consequences can include harm from failing to treat the actual condition or mistreating it, and the costs associated with these issues.
A medical diagnostic error can take three forms: a missed diagnosis, a wrong diagnosis (known as a misdiagnosis), and a delayed diagnosis.
- A missed diagnosis refers to a situation in which the patient’s medical problem is never fully explained or diagnosed. In this situation, a medical professional fails to diagnose the patient at all.
- A wrong diagnosis (also referred to as a misdiagnosis) is defined as an incorrect or mistaken diagnosis. In this situation, a medical professional misattributes a patient’s symptoms to the wrong diagnosis. It is important to understand that a missed diagnosis refers to a different situation than a misdiagnosis; a missed diagnosis occurs when a doctor fails to give any diagnosis and a misdiagnosis is when a doctor gives the wrong diagnosis.
- A delayed diagnosis refers to a situation in which the correct diagnosis is ultimately made, but should have been arrived at earlier.
Studies show that medical diagnostic errors are the most common errors in primary care. In fact, one study that made national headlines found that at least 1 in 20 adults is misdiagnosed in outpatient clinics in the U.S. every year, amounting to 12 million people nationwide.
What are the most common missed diagnoses?
The most common missed diagnoses include cases in which a person undergoes an exam in preparation for surgery, and the exam yields signs of a separate issue, but the doctor misses those signs because he or she is only looking at a certain area or for certain things that pertain to the upcoming procedure. For example, when a patient has a pre-op chest x-ray that reveals a lesion in the lung that may represent lung cancer, but no one makes note and follows up on it.
What are the most common misdiagnoses or wrong diagnoses?
The chart below lists some common misdiagnoses based on what the actual condition is and what medical professionals mistake it to be:
| Actual Condition | Common Misdiagnoses for Condition |
| Cancer | Benign mass, Tuberculosis |
| Heart Attack | Flu, Chronic Pain, Pulmonary Embolism, Heartburn |
| Stroke | Vertigo, Migraine, Alcohol Intoxication |
| Pulmonary Embolism | Heart Attack, Pneumonia, Chest Cold, Asthma |
| Appendicitis | Pelvic inflammatory disease, Endometriosis, Ovarian cyst or torsion, Ureterolithiasis and renal colic, Degenerating uterine leiomyomata, Diverticulitis |
| Depression | Hypothyroidism, Chronic Fatigue Syndrome, Diabetes |
| Fibromyalgia | Rheumatoid arthritis, Lupus, Chronic Fatigue Syndrome |
| Celiac Disease | Irritable Bowel Syndrome, Crohn’s Disease |
| Lyme Disease | Mononucleosis, Flu, Chronic Fatigue Syndrome, Fibromyalgia, Depression, Meningitis |
| Thyroid Disease | Depression |
| Lupus | Rheumatoid arthritis, Fibromyalgia, Chronic Fatigue Syndrome |
| Parkinson’s Disease | Alzheimer’s, Stroke, Stress, Traumatic Head Injury, Essential Tremor |
| Multiple Sclerosis | Viral infection, Lupus, Alzheimer’s, Bipolar Disorder |
| Chronic Fatigue Syndrome | Sinus problems, Hepatitis, Fibromyalgia, Lupus, Rheumatoid Arthritis |
| Rheumatoid Arthritis | Other types of Arthritis, Wegener’s granulomatosis, Fabry disease |
| Polycystic Ovary Syndrome | Perimenopause, Endometriosis, Cushing’s syndrome, Hypothyroidism, Hyperprolactinemia Ovarian tumor, Adrenal gland tumor |
| Endometriosis | Appendicitis, Ovarian cysts, Bowel obstruction, Colon cancer, Diverticulitis, Ectopic pregnancy |
Table sources include Everyday Health, Health.com, World Care, and AARP Health.
What are the most common delayed diagnoses?
The most common delayed diagnoses include cancer, aortic dissection, and diabetes. The most commonly delayed diagnoses of cancers include breast, lung, colorectal, ovarian, and skin.
Where do diagnoses go wrong?
Diagnostic errors can occur at any stage in the diagnostic process and vary among different illnesses and injuries.
For example, cancer diagnostic errors most often occur when doctors neglect to get a biopsy after an abnormal test result. Furthermore, a study conducted by researchers at Johns Hopkins Hospital in Baltimore, Maryland, found that 1 out of every 71 tissue samples were misdiagnosed, meaning that a cancerous biopsy was labeled non-cancerous, and vice-versa. The study also found that 1 out of every 5 cases was misclassified.
Stroke diagnoses are delayed in some cases because initial symptoms can be very variable and the onset of symptoms can appear at varying times across patients. Some patients experience the symptoms of a stroke — weakness, confusion, poor coordination and difficulty speaking — within minutes, which makes the correct diagnosis clearer to doctors. However, when a patient experiences the onset of these symptoms over a period of hours or days, they are more likely to be misdiagnosed. Strokes have also been mistaken for migraines.
What are the implications of a medical diagnostic error?
The implications of a medical diagnostic error vary. These errors can cause patients to receive harmful treatments they don’t need, miss out on treatments they do need, and can cause their actual condition to significantly worsen, even resulting in death. For example, if someone were misdiagnosed with cancer, they could go on to receive dangerous radiation treatments, transfusions, or other procedures that put them at a greater risk for health issues in addition to the original one they came in for that the doctor thought was cancer. On the flip side, if a patient actually had cancer, but was either misdiagnosed or their diagnosis was delayed, their cancer could spread and even kill them before the doctors figured out and treated the actual disorder.
The implications of a medical diagnostic error can be truly devastating. They affect not only the patient, but also family members. They can also result in psychological repercussions, such as, but not limited to, depression and anxiety.
Finally, these errors can have a serious financial impact. Each doctor visit, second opinion, treatment, medication, procedure, comes at a hefty price. In fact, a study of 25 years of medical malpractice suits found that diagnostic errors — not surgical mistakes or medication overdoses — accounted for the largest fraction of claims, the most severe patient harm, and the highest total of penalty payouts. Diagnosis-related payments amounted to $38.8 billion between 1986 and 2010.
How common are medical diagnostic errors?
The proper method of measuring the incidence of medical diagnostic errors is a highly researched and highly contested subject in the field of medicine. Most often, diagnostic errors are measured in autopsy studies. A report by the Institute of Medicine (IOM) found that autopsy studies spanning decades have shown that diagnostic errors contribute to approximately 10% of patient deaths.
Other studies examine living patients, medical malpractice suits, and outpatient care vs. ER and inpatient care to determine the rate of diagnostic errors. The study mentioned in the previous section that reviewed 25 years of medical malpractice suits found that about 80,000 to 160,000 patients suffer permanent disabilities from misdiagnosis each year.
Another study estimated that the frequency of diagnostic error is at least 5% in U.S. outpatient adults.
Is there anything I can do to help prevent diagnostic error?
The Society to Improve Diagnosis in Medicine recommends that:
Patients can help avoid diagnostic errors by becoming more knowledgeable about the diagnostic process; engaged patients have the best outcomes. The IOM recommends that patients become a full partner in their own care, and patients can be an important safety net in catching diagnostic errors before they lead to harm.
Physicians can help avoid diagnostic errors by better understanding the cognitive errors that can commonly occur, and being especially careful navigating their health care systems and resources. Stop to think, use decision support resources, be mindful and reflective, and make the patient your partner in the diagnostic process.
Other prevention tips for patients include:
- Keep track of your symptoms, when they happen, and how severe they are.
- Always tell your doctor the truth about what substances you’re using, from cigarettes to painkillers.
- Ask your doctor to follow up on abnormal test results.
- Ask how long it should take for your medication to work, and follow up if it doesn’t.
- When in doubt, always get a second opinion.
- Remember, you know your body better than anyone. If something doesn’t feel right, keep asking questions.
What do I do if I think I’ve been misdiagnosed?
If you think you’ve been misdiagnosed, try to get a second opinion from an expert or ask for a referral to a medical professional who specializes in your diagnosed condition.
If you’ve suffered the repercussions of a diagnostic error, consider hiring an attorney to help hold the doctor accountable and get funds for treatments and damages.
Feldman Shepherd attorneys specialize in personal injury, medical malpractice, misdiagnoses, and other diagnostic error cases. Feldman Shepherd has secured many multimillion-dollar settlements and verdicts for clients who have suffered a missed, delayed, or misdiagnoses. For a list of results, click here.