Medical Errors and the United States Healthcare System _ ___________________________________________
prevented. For example, failure to conform to hand hygiene standards can lead to preventable infections [21]. • Surgical errors: Wrong-site, wrong-procedure, wrong-patient errors should never occur and indicate serious safety problems within an organization. Recent studies show that these types of errors occur in about one of 112,000 surgical procedures or that an individual hospital would experience such an error every five to 10 years. However, these data sets only include procedures in the operating room. If procedures performed in other settings, such as ambulatory surgery centers, were to be included, the rate of such errors may be significantly higher [23].
manufacturers, healthcare professional, and consumers through MedWatch, the Agency’s safety information and adverse event reporting program [20]. • Infection-related errors: According to the U.S. Centers for Disease Control and Prevention (CDC) on any particular day, approximately one in 25 patients has at least one healthcare associated infection [21]. The main types of infection include: pneumonia (22%), surgical site infections (22%), gastrointestinal infections (17%), and device associated infections, which include central line infections, catheter-associated UTI, and ventilator- associated pneumonia (26%) [22]. It is impossible to estimate the percentage of hospital acquired infections that are avoidable, but evidence shows that many of these infections can and should be
THE 5 MOST MISDIAGNOSED CONDITIONS 1. Cancer-Related Issues: Early and accurate diagnosis of cancer is important to optimize patient outcomes in terms of local disease control, overall survival, and health-related quality of life.1 Cancers detected before they metastasize are easier to treat and associated with better outcomes and survival rates. For example, lung cancer diagnosed at the localized stage has a relative 5-year survival rate of 57% compared with 7% when found at the distant or metastatic stage.2 A recent review found that the highest cancer misdiagnosis rate was for lung cancer at 22.5%, while the lowest misdiagnosis rate was for prostate cancer at 2.4% [3]. Misdiagnosis of lung cancer can result from failure of the provider to recognize symptoms, such as shortness of breath and coughing up blood, that often overlap with other common conditions, including pneumonia, asthma, chronic obstructive pulmonary disease, acid reflux, and tuberculosis [4]. Additionally, approximately 90% of missed lung cancer cases occur on chest X-ray . Although CT is much more sensitive than chest radiography, lung cancer can still be missed. In these cases, observer error, lesion characteristics, and technical defects are the main causes of missed lung cancer [5]. 2. Neurologic-Related Issues: Misdiagnosis in patients with neurologic symptoms associated with conditions such as multiple sclerosis (MS), epilepsy, Bell’s palsy, dementia, and migraine, may result in ineffective and potentially toxic treatment. Misdiagnosis of MS may expose patients to the adverse effects of disease-modifying agents with no chance of benefit while misdiagnosis of epilepsy may expose patients to the risks of antiepileptic drugs and potential loss of a driving license or job. In addition, as occurs with misdiagnosis in other conditions, misdiagnosis fails to address symptoms, delays appropriate therapy, and may result in a worse prognosis [6]. MS is often misdiagnosed because it remains a clinical diagnosis that relies on appropriate interpretation of radiologic data in patients with an appropriate history and neurologic examination. In a study[7] of patients misdiagnosed with MS, alternate diagnoses included migraine alone or in combination with other diagnoses 22%, fibromyalgia 15%, nonspecific or nonlocalizing neurologic symptoms with abnormal MRI 12%, conversion or psychogenic disorders 11%, and neuromyelitis optica spectrum disorder 6%. Duration of misdiagnosis was 10 years or longer in 33% of patients and an earlier opportunity to make a correct diagnosis was identified for 72%. In addition, 70% of patients received disease-modifying therapy and 31% experienced unnecessary morbidity because of the misdiagnosis [7]. 3. Cardiac-Related Issues: Despite significant advances in the diagnosis and treatment of cardiac conditions, misdiagnosis remains a concern. Although heart disease is often considered a man’s disease, almost as many women as men die of heart disease each year in the US [8]. Heart disease is the leading cause of death in women, responsible for 1 in every 4 deaths. But almost two-thirds of women who die suddenly from heart disease had no previous symptoms. Diagnosis of an impending heart attack in a woman may be more difficult than in men, because women often show different early signs and symptoms [9]. A study of closed medical malpractice claims involving undiagnosed heart disease in women from 2011 to 2015, found that in 70% of claims the patient died when her heart condition was not correctly diagnosed and 28% had heart muscle damage from myocardial infarction [9]. The diagnosis of heart failure can be easily missed due to similar symptoms with other conditions especially respiratory diseases. A recent review found that the rate of misdiagnosis of heart failure ranged from 16.1% in the hospital setting to 68.5% when a general practitioner referred patients to a specialist setting. The most common cause for misdiagnosis in this study was chronic obstructive pulmonary disease [10].
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