Certainly, it is terrible to be diagnosed with a serious illness. Even worse? Having a serious illness that doctors misdiagnose, leading to delays in treatment, and potential worsening of your health. Conversely, a misdiagnosis can lead to you receiving unneeded treatments, possibly introducing medication and treatment side effects. Fortunately, there are steps you can take to reduce your risk of diagnostic error.
What exactly is a misdiagnosis and how common is it?
Diagnostic errors include missed, incorrect, or delayed diagnoses.
What are the top missed diagnoses?
Diagnosing an illness can be tricky because doctors must use their judgment and experience, along with test results, to determine possible causes of ailments. Moreover, every patient is different, and symptoms can vary. Additionally, as time passes and more information becomes available (through testing, etc.) the diagnosis can change.
Experts say a good diagnosis requires “communication, openness, humility, and teamwork — with the patient as a key member of the team.” However, this process can be hampered by timid patients, doctors interrupting patients, and rushed appointments.
What causes diagnostic errors?
One analysis gathered focus groups of doctors to analyze 836 diagnosis cases. Their goal was to identify where the diagnosis went wrong, and what factors made the diagnosis harder than usual.
Importantly, the team identified the following failures in the process, in order of frequency from highest to lowest:
- Failure to order a needed test.
- Failure to consider the correct diagnosis.
- Lack of follow-up, or a delay, for an abnormal test result.
- Failure to properly consider a critical piece of the patient’s history.
- Delay, or failure, to order a referral.
Another study provides insight into diagnostic errors.
Interestingly, one study provides insight into all the ways the diagnostic process can breakdown. Researchers analyzed diagnoses provided during primary care visits at a large VA facility and found that 80% of diagnostic errors were due to process breakdowns in 5 areas:
Patient-doctor appointment issues, related to:
- Patient history
- Physical exam
- Ordering diagnostic tests
Diagnostic test issues:
- Tests not performed
- Incorrectly performed tests
- Tests interpreted incorrectly
- Doctors not following-up to learn of abnormal diagnostic test results
- Lack of scheduling follow-up visits with the patient, after abnormal results
- Lack of appropriate actions from follow-up appointments with other physicians
- Communication breakdown between doctors
- Delay in seeking care
- Non-adherence to treatments and medications
- Not following doctor’s advice
- Not attending doctor’s appointments
Confident doesn’t equal correct.
Importantly, don’t let a doctor’s confidence give you a false sense of security about your diagnosis.
Simply put, doctors, like all humans, tend to make assumptions and stick to them. For example, diagnostic error expert Mark Graber, MD, said “clinicians often make the wrong diagnosis when they’re absolutely certain they’re right — and this happens often too quickly, upon seeing the patient and barely getting started with an exam.”
Certainly, doctors are likely to base a diagnosis on seemingly similar cases they have treated before. However, research shows that being confident is not a reliable indicator of whether a diagnosis is correct. Importantly – just because your doctor seems confident doesn’t mean he/she is right!
Additionally, another team of researchers found that confident doctors make diagnostic errors. In this study, doctors diagnosed 4 cases – 2 easy and 2 more complicated. Although the doctors only correctly diagnosed 5.8% of the difficult cases presented, their confidence in their diagnoses was high.
Importantly, this can cause patient harm since doctors who feel confident in their diagnosis may not consider other options. For instance, confident doctors may be less likely to deliberate further, order additional testing, refer patients to specialists, and use reference materials for research. And they may discourage patients from getting a 2nd opinion.
Additionally, doctors often mistakenly believe they won’t make a diagnostic error. Lastly, many believe diagnostic errors usually involve rare diseases, which is not always the case.
10 steps to reduce your risk of diagnostic error.
Fortunately, you can reduce your risk of diagnostic error:
- Research your symptoms before your appointment and make a list of possible diagnoses.
- Make a list of questions and ask each one. Importantly, don’t let your doctor intimidate you into silence.
- Be sure your doctor understands your “story”. And don’t let the doctor cut you short. Certainly, if the doctor interrupts you, continue with your story when the doctor finishes speaking. And don’t grow tired of telling your story – be persistent. Learn more: Doctors Interrupting Patients Can Impact Our Health.
- When doctors ask yes/no questions, feel free to elaborate if you feel it would be helpful. Conversely, if you don’t understand something your doctor tells you, ask him/her to repeat the information until you feel confident you understand.
- Even when given what seems like a definitive diagnosis, ask your doctor if there are other possible diagnoses. Since doctors can become fixated on a particular diagnosis, they may be looking to confirm, not challenge, their diagnosis, even when other options may exist. And if your doctor’s diagnosis doesn’t make sense to you, tell him/her, during or after the appointment.
- Don’t assume that “no news is good news”. Importantly, mark your calendar with the date of your expected test results. And then make sure you call the doctor’s office if you don’t hear by the expected date.
- Don’t assume each specialist on your team is communicating – doctors frequently do not send or receive reports from other doctors.
- Importantly, if something doesn’t seem right, speak up.
- Get a 2nd, or even 3rd, opinion from a different hospital or medical group if possible. Learn more: Why are Second Opinions Important?
- Since communication is key, find a new doctor if your doctor doesn’t listen to you.
Because being engaged in your care can help you reduce your risk of a diagnostic error, read these posts:
- Why Take Detailed Notes at Doctor Appointments?
- Should You Record Medical Appointments?
- Can You Trust Medical Information Online?.
- Can You Trust Advice from Other Patients?
- Understanding Medical Information Is Harder Than Most Realize.
- The Dangers of Too Many Tests and Treatments for Patients.