Good data: the truth is liberating.
In malpractice cases, the most common issue isn’t a goof in the operating room. Instead, it’s good old fashioned diagnosis.
The doctor who delays a treatment because he/she doesn’t think it’s necessary can kill. Or deployes the wrong treatment by mistaking one disease for another.
Coverys is an insurer that specializes in medical malpractice and workman’s comp. Their statisticians did a root cause analysis on 10,000 closed cases, and they issued a report, available on line.(1)
One of the findings is summarized in the chart below.
Diagnosis is hard and not everyone is equally talented at doing it.
- A lot of illnesses have similar symptoms.
- The diagnostician has to be widely ready, quite open-minded, able to connect odd pieces of information and turn them into a narrative (what I call, “connecting the dots”).
- He/she has to be able to pry complete information out of patients or their family, not always an easy task.
- The doctor also needs a sixth sense to know when a key piece of data is missing or wrong.
Medscape sums it up like this:
But for doctors, finding a difficult condition is rarely an epiphany in which the answer shoots up in a burst of fireworks. It’s a combination of many things, including a solid knowledge base, good listening skills, ordering the right tests and interpreting them correctly, performing a skillful examination, and — perhaps most important — thinking creatively.(2)
That’s a lot to ask, and a lot of medical professionals simply don’t have the skills to be able to do it well.
Medscape reported on another study on diagnostic errors on 2013.(2) In reviewing 212,165 patient visits to two major hospitals, they identified 190 cases in which diagnostic errors had the opportunity to cause “moderate to severe harm” to the patient.
Further, the errors concerned relatively common illnesses such as pneumonia, congestive heart failure, urinary tract infections, cancer and renal failure, and not the strange and exotic disease that a doctor might encounter once in a lifetime.
In the Coverys report, 1/3 of the malpractice suits involved death of the patient. When we talk about the potential for serious harm to a patient, we do mean serious.
You need a doctor who is a very good diagnostician. They exist, but it may take a bit of effort to find one.