Previously I linked to an article that discussed rates of misdiagnosis. The article noted how high the rates are and that they occur in a variety of settings – emergency departments, outpatient settings such as your doctor’s office, and inpatient settings. This most recent article looks at the emergency department and noted that there are several types of diagnoses that are most often wrong, Things like heart attacks, strokes and some other diseases may be missed and felt to be something different or less serious. When this happens a needed treatment may not be given. These misdiagnosis can be made by excellent doctors when they weigh what the patient says, the physical findings and a variety of test results. They then consider the different disease that may cause these symptoms and decide on a course of action. But they may be wrong. For example they may think the pain in your abdomen is something like an ulcer, but it turns out to be a heart attack. In this case the doctor misdiagnosed you and because you did not get proper and timely treatment, you could get much sicker.
When discussing a medical error, it has been described as follows by two leaders in the field of patient safety. Medical error: the failure of a planned action to be completed as intended (an error of execution) or the use of a wrong plan to achieve an aim (an error of planning) (James Reason, 1990). An unintended act (either of omission or commission) or one that does not achieve its intended outcome (Lucian Leape, 1994). An example of a medical error meeting these definitions would be accidentally giving a patient a medication they are allergic to. Another example would be doing a planned surgery, but doing the surgery on the wrong side of the body. And crafting a plan of action to treat a patient for pneumonia when they actually have a blood clot in the lung would seem to fit into the idea of “using the wrong plan to achieve an aim”.
When trying to build a safer health system it is important that people are not blamed for making errors so that they are willing to talk about the events that happened. Plus, many errors have system related problems that contribute to the error. For example, if you are forced to work long shifts with overtime, exhaustion can contribute to errors. An important thing to remember about errors, including misdiagnosis, is that they are not intentional. When we make people feel shame and fear for unintentional errors, they may try to hide them. This makes it much harder try and improve the systems and training that people in health care get so that overtime we can reduce instances of medical error.