In at least 50,000 cases per year, primary care physicians in the United States misdiagnose their patients, according to the study published in the Journal of the American Medical Association.
The authors looked at 190 diagnostic error cases at two different healthcare facilities, in which patients unexpectedly returned or were hospitalized within two weeks of their initial visit. Altogether, only one-tenth of one percent of primary care visits resulted in a misdiagnosis.
“But, given that there is like 500 million outpatient visits a year, the absolute number of missed cases is pretty high.”
That’s Dr. Eric Thomas with the University of Texas Health Science Center in Houston and one of the authors of the study. He says pneumonia, congestive heart failure, urinary tract infections, kidney failure and cancer were the diagnoses that were missed most often by primary care providers. Eighty-five percent of all misdiagnoses resulted in considerable harm to death for the patients.
“And the problem turned out to be mostly issues related to the actual patient-provider encounter; problems with getting all the information from the patient and the history, either not asking questions or patients not providing information.”
He also attributes some of the misdiagnoses to not ordering the right tests or misinterpreting test results.
He blames physicians’ time constraints and difficulties accessing information in electronic health records. But he says the most important factor is the complexity of patients nowadays.
“Many of my patients have 5, 10, even 15 active medical problems and they might have one or two medications for each one of those things.”
This can make it hard to determine if a new symptom is related to an existing ailment, a new one, or if it’s a medication side-effect. Thomas says one way to diminish the chances of a misdiagnosis is to consider the patient-provider encounter as a partnership.
“Working with your physician as a partner as time goes on to, again, make sure you’re telling them, giving feedback to the office about how you’re feeling, and if you’re not getting better, you know, they need to know that. And be persistent about making sure that a diagnosis has been made or that steps are being taken to reach the correct diagnosis.”
Combined with estimates of misdiagnoses at U.S. hospitals, the study suggests more than 150,000 patients might be misdiagnosed each year.