Thursday, May 22, 2008

Diagnostic errors in medicine: excellent paper

On January 10, I wrote a blog on medical errors.

This month, an excellent paper came out on the subject of diagnostic errors.

This citation

Volume 121, Issue 5, Supplement, Pages S2-S23 (May 2008)
Overconfidence as a Cause of Diagnostic Error in Medicine
Eta S. Berner, Mark L. Graber

The authors concentrate on doctor overconfidence. The paper indicates that doctors seldom follow published medical guidelines, seldom refer to books, seldom refer to general omputer-based diagnostic aids, and have a more-or-less reflexive approach to diagnosis. Not surprisingly, the authors' review of the literature also indicates that diagnostic accuracy has not improved much over the decades.

None of this is surprising. A prior publication indicates that many doctors and nurses (less so nurses than doctors) do not wash their hands when they should (See: Lipsett PA, Swoboda SM. Handwashing compliance depends on professional status. Surg Infect (Larchmt). 2(3):241-245, 2001). Some of the most vicious hospital outbreaks of antibiotic-resistant organisms are exacerbated by inadequate handwashing among hospital staff. If doctors can't be bothered to wash their hands, how can you expect them to be responsible in the more demanding areas of patient care?

A prior blog was focused on "failure to rescue". "Failure to rescue" - the failure of hospital staff to recognized and act upon developed symptoms and signs that require immediate action to stem a cascade of events that can lead to death - is a bigger problem than misdiagnosis. Most misdiagnoses resolve in one way or another without leading to a patient's death (the patient gets better despite the misdiagnosis, the patient goes to another doctor who makes the correct diagnosis, the patient's disease is not amenable to treatment whether diagnosed correctly or incorrectly, and so on).

I encourage physicians and other patient-care professionals to read these articles. Understanding the source of medical errors is a good start towards improving care.

In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases.

I urge you to read more about my book. There's a generous preview of the book at the Google Books site. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

- Jules J. Berman, Ph.D., M.D. tags: common disease, orphan disease, orphan drugs, rare disease, subsets of disease, disease genetics, errors, handwashing, physicians, standard of care, cad, hand-washing