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?
A diagnostic error is any mistake or failure in the diagnostic process that leads to a wrong diagnosis, a missed diagnosis, or a delayed diagnosis.
Critically, research shows diagnostic error rates of diagnostic error rates of 10-15%, causing about 10% of patient deaths. Experts believe it is “likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequence”.
Interestingly, a study published in 2014 found that about 5% of US adults (approximately 12 million people) are misdiagnosed in outpatient settings every year. Concerningly, the study’s authors estimate that about 50% of these errors could potentially be harmful.
Alarmingly, a 2022 study by the Agency for Healthcare Research and Quality estimates that out of the 130 million annual visits to US emergency departments, roughly 7.4 million (about 6%) people are inaccurately diagnosed every year. Furthermore, these diagnostic errors led to as many as 250,000 deaths, while another 370,000 patients suffered serious harm. These diagnostic errors included failures to identify serious medical conditions like stroke, sepsis, and pneumonia.
Additionally, a study evaluated diagnostic errors among adult patients who were transferred to an intensive care unit (ICU) or who died in the hospital. In a study of 2428 patient records from 29 academic medical centers in the US, 23% of patients experienced a missed or delayed diagnosis. Importantly, 17% of these diagnostic errors caused temporary or permanent patient harm or death. However, among the patients who died, the researchers determined the diagnostic error contributed to 6.6% of the deaths. The diagnostic mistakes included issues related to patient assessment, and problems with test ordering and interpretation.
What are the top missed diagnoses?
A 2022 report outlines a comprehensive review of diagnostic errors by a team of doctors. The group analyzed malpractice claims, patient safety incident reports, and morbidity and mortality reports to create this list of the top 10 missed diagnoses, in order of frequency (from highest to lowest):
If you want to reduce your risk of diagnostic error, it’s helpful to understand how doctors diagnose their patients. 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. Importantly, their goal was to identify where the diagnosis went wrong, and what factors made the diagnosis harder than usual.
Interestingly, the most common failures in the diagnostic process were, in order of frequency from highest to lowest, were:
- 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.
In addition to these 5 most common diagnostic issues, the study also identified other diagnostic pitfalls, as follows:
- Mistaking one disease for another.
- Misinterpreting test results, including failing to take the test’s limitations into consideration.
- Failure to recognize atypical presentations, signs, or symptoms.
- Failure to recognize the urgency of a diagnosis.
- The dangers of intermittent symptoms, which may be absent at the time of an appointment or test.
- Failure to consider a drug or environmental cause.
- Confusion regarding a patient’s observable response to a treatment.
- Failure to appreciate the limitations of a physical exam.
- Presuming that a chronic disease is the cause of new symptoms.
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:
- Before every appointment, write down your symptoms, concerns, and questions. Share all your information with your doctor.
- Make sure your doctor understands your “story”. And don’t let the doctor cut you short. If interrupted, continue your story when the doctor finishes speaking. And don’t grow tired of telling your story. 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.
- Even when given what seems like a definitive diagnosis, ask 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.
- Bring a complete list of medications taken and test results to every appointment, which can help your doctor diagnose you. For instance, your symptoms may be caused by a medication prescribed by another doctor.
- 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?
- Don’t assume “no news is good news”. Importantly, mark your calendar with the date of your expected test results and call the doctor’s office if you don’t hear by the expected date.
- If your symptoms persist despite receiving treatments, tell your doctor. Although the treatment may not be working, it’s also possible the diagnosis was wrong. Ask your doctor if your condition may have been misdiagnosed.
You might want to research your symptoms before your appointment and make a list of possible diagnoses to share with your doctor. However, beware of the large quantity of false medical information online. Therefore, I urge you to only use reputable sites – find a list here.
And since communication is key, if you feel your doctor doesn’t listen to you, consider finding a new doctor.
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 Medical Tests and Treatments.
NOTE: I updated this post on 2-20-24.