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Misdiagnosis Rate

Posted: Fri 24 May 2013 0:40
by radicale
Having been confronted with lackluster MD diagnostic skills I embarked on a fact finding search to answer the following question: how common are missed, delayed and incorrect diagnosis. It is sad that I had an extremely difficult time finding those figures; however, what I managed to find was not impressive. Misdiagnosis rates of 25% appear to be widespread, please refer to the studies below for full details. What I was unable to find was misdiagnosed rates for Lyme Disease taking into account not only false negatives but MD errors in judgment. Is anyone aware of one?

1. Anderson RE, Hill RB, Key CR. The sensitivity and specificity of clinical diagnostics during five decades: toward an understanding of necessary fallibility. JAMA 1989;261:1610-1617.

2. Roosen J, Frans E, Wilmer A, et al. Comparison of premortem clinical diagnoses in critically ill patients and subsequent autopsy findings. Mayo Clinic Proceedings 2000;75:562-567.

3. Renfrew DL, Franken EA, Berbaum KS, et al. Error in radiology: classification and lessons in 182 cases presented at a problem case conference. Radiology 1992; 183:145-150.

4. Garland LH. On the scientific evaluation of diagnostic procedures: presidential address—thirty-fourth annual meeting of the Radiological Society of North America. Radiology 1949;52:309-328.

5. Shively CM. Quality in Management Radiology. Imaging Economics 2003 Nov, http://www.imagingeconomics.com/issues/ ... 3-1111.asp

6. Borgstede JP, Lewis RS, Bhargavan M, Sunshine JH. RADPEER Quality Assurance Program: a multifacility study of
interpretive disagreement rates. Journal American College Radiol 2004;1:59-65.

7. van Rijn JC, Klemetsö N, Reitsma JB, et al. Observer variation in MRI evaluation of pati ents suspected of lumbar disc herniation. AJR 2005 Jan;184:299-303.

Re: Misdiagnosis Rate

Posted: Sat 25 May 2013 2:09
by Lorima
Excellent topic. Of course, this is hard to measure, and it's not something medicine will be eager to publicize. But there are always a few people tackling these embarrassing issues.

Naturally, I think Lyme disease misdiagnosis is currently impossible to study realistically, in mainstream medicine, because of the mistaken diagnostic guidelines. Cases such as Camp Other's, which involved an untreated EM in a county that the CDC had certified as endemic, would qualify, but all those in which the guidelines were followed but the disease was not detected, would not count, no matter what harm resulted from the LD progression, plus inappropriate treatment for whatever wrong diagnosis was made, instead.

The CDC's old estimate (made before the CDC was co-opted by the group following Steere) that only 10% of cases are detected in the surveillance definition and reports, is relevant in some ways, but it was just a guess even then, and I'm sure they've completely repudiated that view, now that they no longer make the distinction between high-specificity tests being suitable for surveillance but not for diagnosis.

I don't have any European information, unfortunately since this is LNE, but I don't see why they would have any less misdiagnosis, for Lyme or in general; the medical cultures seem to be similar, except for how payment is done,

I collected a series of articles from the mainstream press, and they're saying various studies have founds rates of misdiagnosis ranging from 15% to 44%. Nobody claims it's not a big problem.

Jerome Groopman's book How Doctor's Think is great on this subject, and enjoyable to read. My public library has several copies.

http://www.nytimes.com/2006/02/22/busin ... hardt.html
Why Doctors So Often Get It Wrong

By DAVID LEONHARDT
Published: February 22, 2006

snip

With all the tools available to modern medicine — the blood tests and M.R.I.'s and endoscopes — you might think that misdiagnosis has become a rare thing. But you would be wrong. Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease.

As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930's. "No improvement!" was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation.

This is the richest country in the world — one where one-seventh of the economy is devoted to health care — and yet misdiagnosis is killing thousands of Americans every year.

How can this be happening? And how is it not a source of national outrage?

A BIG part of the answer is that all of the other medical progress we have made has distracted us from the misdiagnosis crisis.

Any number of diseases that were death sentences just 50 years ago — like childhood leukemia — are often manageable today, thanks to good work done by people like Dr. Bergsagel. The brightly painted pediatric clinic where he practices is a pretty inspiring place on most days, because it's just a detour on the way toward a long, healthy life for four out of five leukemia patients who come here.

But we still could be doing a lot better. Under the current medical system, doctors, nurses, lab technicians and hospital executives are not actually paid to come up with the right diagnosis. They are paid to perform tests and to do surgery and to dispense drugs.

There is no bonus for curing someone and no penalty for failing, except when the mistakes rise to the level of malpractice. So even though doctors can have the best intentions, they have little economic incentive to spend time double-checking their instincts, and hospitals have little incentive to give them the tools to do so.

"You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality."

There are some bits of good news here. Dr. McClellan has set up small pay-for-performance programs in Medicare, and a few insurers are also experimenting. But it isn't nearly a big enough push. We just are not using the power of incentives to save lives. For a politician looking to make the often-bloodless debate over health care come alive, this is a huge opportunity.

Joseph Britto, a former intensive-care doctor, likes to compare medicine's attitude toward mistakes with the airline industry's. At the insistence of pilots, who have the ultimate incentive not to mess up, airlines have studied their errors and nearly eliminated crashes.

"Unlike pilots," Dr. Britto said, "doctors don't go down with their planes."

snip

Re: Misdiagnosis Rate

Posted: Sat 25 May 2013 2:14
by Lorima
http://seattletimes.com/html/opinion/20 ... lchuk.html
Misdiagnosis: Millions of patients are being treated for the wrong conditions
Despite expensive new technologies, millions of patients worldwide are being treated for the wrong conditions, writes Evan Falchuk, vice chairman of Best Doctors, Inc., in Boston. Misdiagnosis means needless suffering and hundreds of millions of dollars wasted each year.

By Evan Falchuk
Special to The Times

WE read and hear a lot of headlines about health-care reform and related costs and hurdles. What we hear a lot less of, though, is misdiagnosis and why correcting the situation should be made a priority.

Despite our "latest and greatest" technologies, 15 percent of all medical cases in developed countries are misdiagnosed, according to The American Journal of Medicine. Literally millions of patients worldwide are being treated for the wrong conditions every year. The Mayo Clinic Proceedings found that 26 percent of cases were misdiagnosed while, according to The Journal of Clinical Oncology, up to a startling 44 percent of some types of cancer are misdiagnosed.

These statistics should be getting a lot more attention.

Misdiagnosis means needless suffering for patients and their families, and in many cases, even lost lives. Secondarily, it also means nearly one-third of the $2.7 trillion spent each year on health care in the U.S. are considered to be wasted dollars.

So how can this still be occurring so regularly, and why have misdiagnosis rates not changed much over the past 30 years?

snip

Re: Misdiagnosis Rate

Posted: Sat 25 May 2013 2:28
by Lorima
http://articles.washingtonpost.com/2013 ... tic-errors

Misdiagnosis is more common than drug errors or wrong-site surgery

By Sandra G. Boodman,May 06, 2013

Until it happened to him, Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn’t think much about the problem of misdiagnosis.

That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor — the size of a peach pit — using a simple procedure that the experienced head and neck surgeons who regularly examined Brook never tried. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.

“I consider myself lucky to be alive,” said Brook, now 72, of the 2006 ordeal, which he described at a recent international conference on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was “really shocked” by his misdiagnosis.

But patient safety experts say Brook’s experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect 10 to 20 percent of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.

Recent studies underscore the extent and potential impact of such errors. A 2009 report funded by the federal Agency for Healthcare Research and Quality found that 28 percent of 583 diagnostic mistakes reported anonymously by doctors were life-threatening or had resulted in death or permanent disability. A meta-analysis published last year in the journal BMJ Quality & Safety found that fatal diagnostic errors in U.S. intensive care units appear to equal the 40,500 deaths that result each year from breast cancer. And a new study of 190 errors at a VA hospital system in Texas found that many errors involved common diseases such as pneumonia and urinary tract infections; 87 percent had the potential for “considerable to severe harm” including “inevitable death.”

Misdiagnosis “happens all the time,” said David Newman-Toker, who studies diagnostic errors and helped organize the recent international conference. “This is an enormous problem, the hidden part of the iceberg of medical errors that dwarfs” other kinds of mistakes, said Newman-Toker, an associate professor of neurology and otolaryngology at the Johns Hopkins School of Medicine. Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic.

The problem is not new: In 1991, the Harvard Medical Practice Study found that misdiagnosis accounted for 14 percent of adverse events and that 75 percent of these errors involved negligence, such as a failure by doctors to follow up on test results.

Despite their prevalence and impact, such mistakes have been largely ignored, Newman-Toker and others say. They were mentioned only twice in the Institute of Medicine’s landmark 1999 report on medical errors, an omission some patient safety experts attribute to difficulties measuring such mistakes, the lack of obvious solutions and generalized resistance to addressing the problem.

“You need data to start doing anything,” said internist Mark L. Graber, founding president of the Society to Improve Diagnosis in Medicine and a leading errors researcher. Despite dozens of quality measures, Graber said, he is unaware of “a single hospital in this country trying to count diagnostic errors.”

In the past few years, a confluence of factors has elevated the long-overlooked issue. In his 2007 bestseller, “How Doctors Think,” Boston hematologist-oncologist Jerome Groopman vividly deconstructed the flawed thought processes that underlie many diagnostic errors, including several he made during his long career.

More recently, an influential cadre of medical leaders has been pushing for greater attention to the problem. They cite concerns about the growing complexity of medicine and increasing fragmentation of the health-care system, as well as relentless time pressures squeezing doctors and the overuse of expensive, high-tech tests that have supplanted traditional hands-on skills of physical diagnosis.

Publicity about the death last year of 12-year-old Rory Staunton, sent home from an emergency room in New York after doctors missed the raging systemic infection that quickly killed him, have put a human face on the problem. At the same time, new digital databases such as IBM’s Watson and Isabel promise to boost doctors’ accuracy, although their usefulness remains a matter of debate.

snip

Some environments are more susceptible to error than others. Graber calls the ER “a petri dish” for diagnostic mistakes: The doctor doesn’t know the patient, the patient doesn’t trust the doctor, and time pressures and frequent interruptions are the rule.

Misdiagnosis is not limited to hospitals; a recent commentary on the Texas VA study by Newman-Toker and Martin Makary estimates that “with more than half a billion primary care visits annually in the United States . . . at least 500,000 missed diagnostic opportunities occur each year at U.S. primary care visits, most resulting in considerable harm.”

There is another reason such mistakes have been long ignored: They are regarded as an unusually personal failure in a profession where diagnostic acumen is considered the gold standard.

snip

“Overconfidence in our abilities is a major part of the problem,” said Graber, who believes doctors have gotten a pass for too long when it comes to diagnostic accuracy. “Physicians don’t know how error-prone they are.”

Many, he noted, wrongly believe that the problem is “the other guy” and that they don’t make mistakes. A 2011 survey of more than 6,000 physicians found that 96 percent felt that diagnostic errors are preventable; nearly half said they encountered them at least once a month.

In the Texas VA study, more than 80 percent of cases lacked a differential diagnosis, in which a doctor not only declares what he believes is ailing the patient but also lists other potential causes of the problem based on symptoms, test results and a physical exam.

“A differential helps people to cognitively focus,” said Hardeep Singh, director of the Houston VA Patient Safety Center of Inquiry. Failure to ask “What else could this be?” can cause premature fixation on the incorrect diagnosis, said Singh, the study’s lead author.


snip

It wasn’t fibromyalgia

While second opinions are one strategy believed to reduce misdiagnosis, the original error may be the basis of a cascade of mistakes.


For nearly three years, beginning in February 2008, financial executive Karen Holliman logged more than 50 visits with various doctors in Durham, N.C., trying to get help for the increasingly severe fatigue that had plagued her for several years as well as back pain so excruciating that she wound up in a wheelchair.

Doctors variously told her she had fibromyalgia, chronic fatigue syndrome or a psychiatric problem. The real reason for her symptoms was metastatic breast cancer, which had riddled her spine, fracturing her back. Signs of cancer had been found on an MRI scan performed in February 2008. But a bone scan performed a few weeks later did not indicate cancer; her internist told her she did not have cancer, and doctors repeatedly failed to investigate the discrepancy.

To make matters worse, Holliman was taking hormone replacement pills prescribed by her internist to combat hot flashes; the drug fed her breast cancer.

“I’m terminal,” she said. In December 2010, when she was told she had Stage IV breast cancer, an oncologist estimated her life expectancy at about three years. “I could have been diagnosed in 2008,” she said, adding that she believes timely diagnosis and treatment might have extended her life expectancy to 10 years.

snip
Dr. Itzhak Brooks, the throat cancer patient described at the beginning of the article, has a website and blog here:
http://dribrook.blogspot.com/

I read his book My Voice; it was good.

Re: Misdiagnosis Rate

Posted: Sat 25 May 2013 13:09
by panda
Concerning the correct identification of Erythema migrans look here:

http://www.lymeneteurope.org/forum/view ... 340#p33036

Re: Misdiagnosis Rate

Posted: Sun 26 May 2013 18:10
by Lorima
PMC abstract with references with links:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1741671/
Postgrad Med J. 2000 July; 76(897): 415–416.
doi: 10.1136/pmj.76.897.415
PMCID: PMC1741671



K. Khunti
Clinical Governance Research and Development Unit, Department of General Practice and Primary Health Care, University of Leicester, Leicester, UK. Email: kk22@le.ac.uk

This article has been cited by other articles in PMC.
Abstract
Autopsies represent a key instrument in educating doctors and may aid quality assurance for primary and secondary care. This study shows that only a few patients have an autopsy, of which the majority are carried out at the request of the coroner for medicolegal reasons. Better education and communication between general practitioners, hospital clinicians, pathologists, and coroners may increase the rate of autopsies.


Free full text: http://www.ncbi.nlm.nih.gov/pmc/article ... p00415.pdf

Image

Re: Misdiagnosis Rate

Posted: Sun 26 May 2013 18:17
by Lorima
Please excuse me for this rare instance of cross-posting; this is so relevant that I think it should be here, too. The original post is here:
http://www.lymeneteurope.org/forum/view ... 265#p36265
Lorima wrote:CO,
I agree that we would like to have accurate autopsy information on this case, and a spinal fluid culture for Bb, or at least a PCR which is relatively quick and cheap. But in most hospitals (even at MGH, Steere's hospital!) there is no mechanism (no box to check) for these lab tests; they are only done in research labs, or ordered by LLMDs from specialty labs. The young doctor had to rationalize, to herself, the unusual step of ordering even the standard Lyme test, since the patient had no known tick exposure.

I think obtaining an autopsy that would detect LD was highly unlikely, too. First, autopsy is not usually done now. Some reasons for this are discussed in the article below, including the fact that the hospital bears the cost, which is substantial. Also, Bb infection would not be detected in a standard autopsy. The pathologists would have to be (a) looking hard for it, (b) skilled in doing so, and (c) allowed the time to do so, in contradiction to the emphasis on speed in medicine.

Here's an example where it was done, by committed LD researchers in Finland:
http://brain.oxfordjournals.org/content ... 3.full.pdf

See this post by hv808ct, showing the attitude of the dominant US Lyme research establishment, including the CDC's Paul Mead, on this subject:
http://www.lymeneteurope.org/forum/view ... how#p33673
hv808ct wrote: snip
by inmacdonald » Fri 4 Jan 2013 1:59

The Connecticut State Medical Chief Medical Examiner has complete discretion over
the scope of the Autopsy. Lyme Focused Autopsies are not practiced anywhere in the world,
as pathologists in busy practice and medical examiners in busy practice have more
work than can be supported by the available staffing.
There are no “Lyme Focused Autopsies” for the simple reason that it is very difficult to die from an actual case of Lyme disease. See:
Clin Infect Dis. 2011 Feb 1;52(3):364-7. doi: 10.1093/cid/ciq157. Epub 2010 Dec 28.
A review of death certificates listing Lyme disease as a cause of death in the United States.
Kugeler KJ, Griffith KS, Gould LH, Kochanek K, Delorey MJ, Biggerstaff BJ, Mead PS.
http://cid.oxfordjournals.org/content/52/3/364.long
snip

Kugeler et al. doesn't tell us much; death certificates are unreliable for causes of death, even without considering the lack of Lyme-focused autopsies, because of

(1) the prevalence of misdiagnosis
JAMA article by George Lundberg, former JAMA chief editor:
http://www.isabelhealthcare.com/pdf/22l ... _aug29.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464859/
http://www.medscape.com/viewarticle/770097
http://qualitysafety.bmj.com/content/ea ... 3.abstract

and

(2) the low priority placed on accuracy of cause of death on certificates, even when the true cause is known.
http://www.medscape.com/viewarticle/803990

Here's an article I enjoyed, about the current low rate of autopsies and its implications.

http://www.jhu.edu/jhumag/295web/boy.html
Autopsy: The Boy Who Died Too Fast

By Elise Hancock

snip

Does Brazas think of Frank as a person, or as a body? He says nothing for a minute. The water gurgles, rinsing the broad ribbon of bowel as it moves slowly across his gloved fingers. He stops to look more closely, to jot a note. "I guess I think of him as a person and a body," he says at last. "Mostly, I just think about the next patient who comes in like this. We'll do better because of what we learn today."

Learning-something-useful is the overwhelming reason to perform an autopsy, and has been since Leonardo da Vinci stealthily picked up a knife and took a look inside. One could argue, in fact, that scientific medicine began in that moment, when Aristotelian theory first gave way to direct observation. By the 19th-century medical revolution, autopsy had come out of the closet to be revered as the only reliable source of information.

How did particular diseases progress within the body? Was the diagnosis correct? Was it complete? What had the treatment accomplished, for better and for worse?

For every case, only autopsy could answer those questions. Only autopsy could help physicians improve their diagnoses and treatments. Autopsy was the only way to teach young doctors the inside of the human body, in all its variety.

The legendary Sir William Osler proclaimed his devotion to autopsy; he personally performed more than a thousand, and he often surged into the autopsy room at Hopkins with full retinue. In 1900, a future president of the American Medical Association (Abraham Jacobi) actually found it necessary to remind his academic colleagues that the practice of medicine included "not only diagnosis and autopsy, but the treatment and care of patients."

Today, though autopsy is still answering the same set of vital questions, the field is facing doubt. In 1950, half of all hospital deaths in the United States were autopsied. Now, including all the people who get a coroner's autopsy by reason of suspicious death or unknown cause of death, the Centers for Disease Control and Prevention estimate autopsies at 12 percent of deaths, and falling.

Apart from the legal mandates that govern coroners, no generally accepted protocol applies to autopsies. Physicians ask for them, or not, according to their individual judgment. No autopsy can be performed without legal permission from the next-of-kin.

When asked, U.S. families deny permission about 60 percent of the time. In a few cases, the reasons are religious; Orthodox Judaism, for instance, has an aversion to autopsy. Other families sometimes think�mistakenly�that the autopsy will delay the funeral, cost them something, or make an open casket impossible. ("Hospitals ordinarily absorb the costs," responds Grover Hutchins. "We can work extremely fast, if we have to. And morticians can do wonderful things. I have never seen a case where you could see any sign of the autopsy" and here he takes a deep breath, leans forward, and speaks with emphasis "even if you knew one had taken place and knew what to look for.")

Physicians know families may find the idea of autopsy repellent, especially in the first burst of grief, and they don't like to ask permission unless they must. Today, given all the new diagnostic tools�MRI and CT scans, laparoscopy, endoscopy, blood chemistry, genetic tests, and more�they less often think they must.

Elliot Fishman, a diagnostic radiologist at Hopkins, speaks for many when he says, "The detail we get of real live patients is so good, that often to get additional information at autopsy is not all that helpful. CT is almost like a living autopsy, the detail is so great." He is sure of that, after conducting research in which lungs were both scanned and autopsied. "Now the diagnosis is made while the patient is living." (Emphasis his.)

Grover Hutchins, a commanding figure behind his slab of a desk, begs to differ. "The CT is absolutely incredible," he rumbles. "It can pick up very subtle changes in the tissue. But can't tell what they are." Hutchins points out that in study after study, over many years, autopsies show that about 10 percent of patients were incorrectly or incompletely diagnosed, to the degree that treating what was missed could have lengthened life, or even cured.
That's a low estimate of misdiagnosis: see the articles I cited above, for example, where rates of 10% to 40% are mentioned, and also this recent thread
http://www.lymeneteurope.org/forum/view ... =11&t=4839

Hancock:
Of course, the missed diagnoses change over time. For instance, leukemia used to be hard to diagnose, but today is almost never missed. Now the main stumbling block is infection: Bacteria, viruses, and fungi are on the upswing, in new, unexpected, and more virulent forms. Not only that, today's sickest patients often have not one but several medical problems, which makes it more likely that something will be missed. One disease can mask another, or make a full workup impossible, or simply get lost in the confusion. So old problems get solved, new ones arise, and the 10 percent holds steady.

"Ten percent?" says Fishman. He just can't believe it. "Well, you might say this: How often do you get autopsies now? Not that often. When do you get them? In select difficult cases. And that's how you might have a high percentage." In other words, sampling error.

Pathologists have wondered about that too. The resulting research indicates that no one, pathologist or clinician, can predict which autopsies will produce a big surprise. Being sure is not the same as being right. "Yeah, they're sure of the diagnosis," says pathologist Barbara Crain. "But they turn out to be wrong." By the same token, even when physicians are not sure, the diagnosis (and resulting treatment) can be correct.

Surprises at autopsy could be fuel for malpractice suits, or so one would think. "I have wondered sometimes," says pathologist John Yardley, "about the degree to which physicians do not seek autopsy because they know an autopsy may work against them." But of course the converse can also be true: Seeking autopsy shows confidence, and autopsy findings can form a basis for defense.

Which way it more often works is unclear, says Hutchins. "At the trial, there'll be some expert on each side who will support the argument made by that side, or they wouldn't be there." What the jury makes of it all, who can tell. "The autopsy may be irrelevant. The decision may be based on the jury's assessment of whether clinical care was adequate."
In the case of Merced, the young woman patient in the story. she was properly treated according to guidelines for LD with proper lab evidence. One can always say she should have been given more treatment (which may have been the case, in simple terms of what might have kept her alive) or that she shouldn't have been tested for LD at all, because her symptoms and history weren't exactly what IDSA says they should have been in order to justify testing. At least, nobody argued that she was causing her own symptoms (that they were "somatic"), which is still in style, as the freshly released DSM-5 confirms. See for example this article in the current issue of NEJM:
https://www.dropbox.com/s/k7mui0k7xt84g ... 20anon.pdf

Re: Misdiagnosis Rate

Posted: Sun 26 May 2013 21:30
by panda
C. McDonald, M.B. Hernandez, Y. Gofman, S. Suchecki, W. Schreier:
The five most common misdiagnoses: a meta-analysis of autopsy and malpractice data.
The Internet Journal of Family Practice. 2009 Volume 7 Number 2. DOI: 10.5580/9ce
Abstract
Context
Many papers have compared clinical diagnosis and cause of death (determined at autopsy) and others have used malpractice cases to compare initial clinical diagnoses with final diagnoses. To date, no paper has compiled and combined the outcomes of malpractice and autopsy findings. In this paper, the authors present the five most commonly misdiagnosed conditions (as determined at autopsy and malpractice proceedings) to aid medical personnel and improve patient care. Over 62 autopsy and malpractice studies were reviewed to determine the frequency of various misdiagnoses.

Methods
Meta-analysis of 62 studies was used to compare relative rates of misdiagnosis.

Results
The five most commonly misdiagnosed diseases were (in order) infection, neoplasm, myocardial infarction, pulmonary emboli, and cardiovascular disease.

Conclusions
The results underscore the need to institute policies, procedures, and systems that reduce the most common process errors that lead to the misdiagnosis of these common conditions.
Image
Table 1: Most Commonly Maldiagnosed (based on total incidence) in Autopsy

Image
Table 5: The Five Most Common Maldiagnosed Illnesses (based on total incidence between the autopsy and malpractice data)

http://archive.ispub.com/journal/the-in ... -data.html [free full text]

Re: Misdiagnosis Rate

Posted: Sun 26 May 2013 21:58
by panda
How Common is Misdiagnosis?

snippets:
A study of Patient Safety Incidents (PSIs) by HealthGrades found that "Failure to Rescue", meaning failure to diagnose and treat in time, was the most common cause of a patient safety incident, with a rate of 155 per 1,000 hospitalized patients. Unfortunately, the study did not further break down statistics into the types of misdiagnosis, delayed diagnosis or other factors.

The National Patient Safety Foundation (NPSF) commissioned a phone survey in 1997 to review patient opinions about medical mistakes. Of the people reporting a medical mistake (42%), 40% reported a "misdiagnosis or treatment error", but did not separate misdiagnosis from treatment errors. Respondents also reported that their doctor failed to make an adequate diagnosis in 9% of cases, and 8% of people cited misdiagnosis as a primary causal factor in the medical mistake. Loosely interpreting these facts gives a range of 8% to 42% rate for misdiagnoses.

Misdiagnosis rates in the ICU or Emergency Department have been studied, with rates ranging from 20% to 40%. These misdiagnosis rates are likely to be higher than the overall health care misdiagnosis rate because of the time-critical and serious nature of the diagnosis under these crisis conditions.
[...]
Misdiagnosis and autopsy studies: One useful way to detect misdiagnosis is to perform an autopsy, and then compare the original diagnosis with that found at autopsy. Various studies have found major differences, with discrepancy rates as high as 40% in the Medical ICU (CHEST, February 2001). This rate of 40% in the ICU is undoubtedly higher than the rate for general medicine because of the difficult and often multifactorial nature of serious ICU cases. Unfortunately, autopsy rates are declining for various reasons and the opportunity to measure misdiagnosis in this way is reduced.
http://www.rightdiagnosis.com/intro/common.htm

Re: Misdiagnosis Rate

Posted: Mon 27 May 2013 0:15
by panda
Lorima gave the link of:

Qual Saf Health Care. 2006 Jun;15(3):174-8.
The "To Err is Human" report and the patient safety literature.
Stelfox HT, Palmisani S, Scurlock C, Orav EJ, Bates DW.
Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. hstelfox@partners.org

http://www.ncbi.nlm.nih.gov/pubmed/16751466/ [abstract]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464859/ [free full text]

Background of this research was an earlier report of the Institute of Medicine (IOM) published by:
Kohn L T, Corrigan J M, Donaldson MS (Institute of Medicine)
To err is human: building a safer health system.
Washington, DC: National Academy Press, 2000

http://www.nap.edu/openbook.php?isbn=0309068371
Brief report and summary are free, whole study (312 pages) after signing in.

There is a short section on autopsy, p.269:
Unexpected findings at autopsy are an excellent way to refine clinical judgment and identify misdiagnosis. Lundberg cites a 40 percent discrepancy between antemortem and postmortem diagnoses.[14] Nevertheless, autopsy rates have declined greatly in recent years from 50 percent in the 1940s to only 14 percent in 1985.[15,16] Autopsy rates in nonteaching hospitals are now less than 9 percent.
Lundberg 1998 [Lundberg, G.D. Low-Tech Autopsies in the Era of High-Tech Medicine. JAMA. 280:1273–1274, 1998.] was already mentioned: http://www.isabelhealthcare.com/pdf/22l ... _aug29.pdf