Introduction
It is estimated that 1 in 10 patients with major vascular events, infections, and cancers are misdiagnosed and half of those misdiagnosed die or become permanently disabled as a result (Newman-Toker et al., 2021). Misdiagnosis, also known as diagnostic error, refers to when diagnosis is missed, delayed or incorrect (Singh et al., 2017). Whether it be human error, patient error or errors in diagnosing tools, misdiagnosis can occur at one or several of the following stages: access and presentation, history taking, physical exam, testing, assessment, referral and follow-up (Schiff et al., 2005). Dr. Pooya Beigi, a dermatologist, dermatologist surgeon, and founder of Misdiagnosis Association and Research Institute (MARI), recognizes the importance of addressing misdiagnosis (Blissy, 2024). MARI is an organization that conducts research on misdiagnosis and errors in medicine (Blissy, 2024). This paper will help review the causes, consequences and prevention of misdiagnosis in medicine.
Causes of Misdiagnosis in Medicine
As mentioned earlier, there are 7 main categories where misdiagnosis can potentially occur, however, the cause behind why misdiagnosis can occur in these stages varies.
An important cause for misdiagnosis occurs between patient and provider communication. Doctors rely greatly on patients for information on their health whether it be symptoms, timeline of illness, recent changes in lifestyle or more (Blissy, 2024). Miscommunication or information left out by patients to their doctors can cause misdiagnosis as doctors are unable to treat correctly or within a timely manner (Balogh et al., 2015). For instance, a missed diagnosis is quite common in dermatology whether it be skin cancers, moles or infections (Blissy, 2024). Patients are likely to disregard or ignore these changes to their body especially if they are unable to see them (Blissy, 2024). If a patient does not give proper history on these changes to their skin, many illnesses and diseases are likely to go misdiagnosed causing complications in the future (Blissy, 2024). For example, Dr. Pooya Beigi found that a patient did not visit him when she initially noticed a skin concern due to her busy life until 2 years later (Blissy, 2024). While she was able to seek the care she needed, having the concern checked 2 years prior would have been beneficial to advance her treatment earlier and preventing further complications (Blissy, 2024).
Misdiagnosis can also occur due to errors out of the physician’s or patient’s control. Some examples include errors in diagnostic testing, lack of availability for primary care and testing, and challenges of funding within the healthcare setting (Singh et al., 2017).
Consequences of Misdiagnosis in Medicine
The consequences of misdiagnosis range from zero to significant harm whether it be to the patient, economically, health care systems or healthcare professionals (Balogh et al., 2015).
While in some cases misdiagnosis can pose no harm to patients such as an instance where incorrect treatment through incorrect diagnosis does not affect the patient’s body, misdiagnosis can pose a significant risk to patients’ health in other cases. Complications that occur with illness or disease development when diagnosis is inaccurate or missed as well as risks associated with inaccurate treatment plans when patients are diagnosed with something they do not have are all ways that a patient’s health can be at risk to harm (Balogh et al., 2015). Additionally, a patient may experience prolonged stay in hospitals or additional measures of treatment because of misdiagnosis which can impact patients physically and mentally (Balogh et al., 2015). An example of consequences of misdiagnosis on patients’ health is provided by Schiff et al. (2005), A 50-year-old woman with repeated ED visits for asthma and new back pain was repeatedly treated for asthma exacerbations. Despite previous imaging which ruled out aortic aneurysm, her underlying condition—a ruptured ascending aortic aneurysm—was missed, leading to her sudden death days later. This highlights the dangers of diagnostic errors through a missed and incorrect diagnosis (Schiff et al., 2005).
Along with consequences of misdiagnosis in medicine to patients physically, there are many non-clinical consequences as well. For instance, if a patient receives unnecessary treatment due to misdiagnosis, it can lead to inefficiency of healthcare from professionals as they are partaking in treatments that are not needed (Balogh et al., 2015). There is also increase in costs to cover treatments caused by misdiagnosis (Balogh et al., 2015). Additionally, misdiagnosis can influence patients’ trust in healthcare systems (Balogh et al., 2015). Many individuals may develop fear or reluctancy to visit the hospital or seek help as they or a loved one experienced misdiagnosis.
Prevention of Misdiagnosis in Medicine
One of the most important ways to prevent misdiagnosis in medicine is by patients becoming more active participants in their own health (Blissy, 2024). As stated by Dr. Pooya Beigi, keeping better documentation and giving good information to doctors is essential in healthcare. Whether it be new medicine, recent travelling, new products, new diets or any concerns, oversharing these types of information from patients to their doctors is key to preventing misdiagnosis (Blissy, 2024). This ensures that doctors can make more accurate diagnoses as they have information on symptoms as well as underlying information that may be causing a disease or illness. Misdiagnosis also occurs when individuals think of one illness more than the other and start treatment without thinking there might be other conditions or reasons behind one’s symptoms (Blissy, 2024). To prevent this, healthcare providers must consider all possible diagnoses prior to starting treatment or deciding on a single illness. With an increase of technology in recent years, healthcare systems and up to date diagnostic tools can be used to prevent misdiagnosis (Singh et al., 2017). Systems can be developed to detect errors and create triggers when something seems to be inaccurate. Additionally, up to date technological diagnostic tools can be used for testing or gathering patient data to prevent chance of errors in diagnosis through human error (Singh et al., 2017).
Conclusion
To conclude, misdiagnosis in medicine is an important issue in healthcare due to the vast consequences it has on patients and healthcare. While misdiagnosis can occur due to various reasons such as miscommunication between patients and providers, or causes out of patient or physician control, there are many preventative measures that can be implemented to prevent diagnostic errors. It is essential to initiate strategies like active participation of patients in their own health, good communication between patients and their providers and increase of technology in healthcare to prevent misdiagnosis in medicine.
Reference
Balogh, E., Miller, B. T., & Ball, J. (2015). Improving Diagnosis in Health Care. The National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK338594/
Blissy. (2024, Aug 09). Why Your Skin Issue Might Be Misdiagnosed! Dr. Beigi’s Insights | The Blissy Experience Ep. 10 [Video]. YouTube. https://www.youtube.com/watch? v=yA7PpiNM600
Newman-Toker, D., Wang, Z., Zhu, Y., Nassery, N., Saber Tehrani, A., Schaffer, A., Yu-Moe, C., Clemens, G., Fanai, M. & Siegal, D. (2021). Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”. Diagnosis, 8(1), 67-84. https://doi.org/10.1515/dx-2019-0104
Schiff, G. D., Kim, S., Abrams, R., Cosby, K., Lambert, B., Elstein, A. S., Hasler, S., Krosnjar, N.,Odwazny, R., Wisniewski, M. F., McNutt, R. A., & Agency for healthcare research and quality rockville md. (2005). Diagnosing diagnosis errors: Lessons from a multi-institutional collaborative project. Agency for healthcare research and quality rockville md. https://www.ncbi.nlm.nih.gov/books/NBK20492/
Singh, H., Schiff, G. D., Graber, M. L., Onakpoya, I., & Thompson, M. J. (2017). The global burden of diagnostic errors in primary care. BMJ Quality & Safety, 26(6), 484-494. https://doi.org/10.1136/bmjqs-2016-005401
Provided and edited by the members of MARI Research, Error in Medicine Foundation, and MISMEDICINE Research Institute, including Charmi Patel, Bukky Alausa, and Dr. Pooya Beigi, MD. MSc.
