Diagnostic errors, including diagnoses that are delayed, wrong, or completely missed, affect more than 12 million Americans each year. Some of these errors are minor, causing minimal harm, but far too many are extremely harmful, even fatal. Studies have, in fact, suggested that more than 150,000 patients in the U.S. experience diagnosis-related harm each year, and up to 80,000 people harmed by diagnostic errors die annually in hospitals.
It is no wonder then that the U.S. National Academy of Medicine has called diagnostic errors “a major public health problem.” Like other major public health problems, this one has been analyzed and studied. Unlike many other public health problems, however, the research suggests that diagnostic errors are largely preventable.
In this blog post, we’re going to present a case showing the serious consequences of doctors’ failure to diagnose medical conditions correctly, analyze factors that contribute to these failures, and suggest what victims of these errors and their families can do to hold health care organizations and doctors accountable for the harm their errors cause.
Treating the Wrong Disease: A Potentially Fatal Error
A recent Washington Post article illustrates how multiple doctors examining multiple test results and prescribing multiple medications and other treatments can misdiagnose a patient, with life-threatening results. The patient suffered several bouts of pneumonia, a lingering cough, shortness of breath, and fatigue between November, 2016, and May, 2018, but it wasn’t until she vomited and collapsed in her pulmonologist’s exam room and was rushed to a hospital that her underlying condition, advanced heart failure, was diagnosed.
Fortunately, Multop’s life was saved by doctors at the hospital who diagnosed and treated her advanced congestive heart failure. However, the damage to her heart was so extensive that she recovered only after seven weeks in the hospital and a heart transplant. She is thankful that she is now healthy (but with less endurance and a fragile immune system), but troubled that all of the doctors she saw during her year and a half struggle all failed to diagnose her condition correctly.
The Role of Cognitive Biases in Diagnostic Errors
With all of the advanced tests, technology, and training available to doctors today, we might well wonder how mistakes like those in Multop’s case occur. Medical research on the issue suggests a plausible explanation: cognitive errors. That is, studies show that at least 75% of all diagnostic errors are the result of common human cognitive errors, such as the propensity to look for only enough information to come to an initial decision/diagnosis (“premature closure”) and the propensity to then stick with that decision/diagnosis even when new information becomes available (“anchoring”).
According to these studies, multiple cognitive biases underlie these errors. More than 100 of these biases have been identified, but some of the more common ones are:
- Ascertainment bias – Making diagnostic decisions based on prior expectations.
- Availability bias – Basing diagnostic decisions on familiar, common, recent, and/or memorable examples.
- Confirmation bias – Selectively seeking information that supports one’s initial impressions.
- Diagnostic momentum – A diagnosis gains momentum and decreases the chances that alternatives will be considered.
- Framing effect – The propensity for judgment to be affected by how information is framed or presented.
- Irrelevant information bias – The tendency to overvalue irrelevant information in making or confirming a diagnosis if the doctor specifically sought this information.
- Status quo bias – The tendency to stick with an initial diagnosis as more alternatives become possible.
Probable Cognitive Errors in the Misdiagnosis Case
In Multop’s case, we can see how these biases led to the failure to diagnose and treat her underlying heart condition. She was originally diagnosed with and treated for pneumonia. When she got pneumonia again six months later, she went to a lung specialist. Availability bias and confirmation bias seem to have come into play at this point, since neither her primary care provider nor her pulmonologist sought information beyond that related to lung diseases.
She was treated for sinusitis and mild bronchiectasis, but her cough lingered, and she got pneumonia again. The pulmonologist prescribed a stronger antibiotic, which seemed to work, until other symptoms – shortness of breath and fatigue – occurred. He referred her to an infectious disease specialist, but continued treating her for bronchiectasis with antibiotics and a device to clear her airways, based on confirmation bias and diagnostic momentum apparently related to his area of specialization.
Six months later a CT scan revealed swollen lymph nodes, fluid around her lungs and heart, and a partially collapsed lung. She went to a cardiologist for a transthoracic echocardiogram and to an interventional pulmonologist for a bronchoscopy. Neither of these specialists nor the tests they performed found anything other than the fluid around the heart and lungs and large quantities of mucus in the lungs. The specialists and Multop’s primary pulmonologist did not look further for an explanation of the fluid or her worsening condition, perhaps because of how information on her ailments had been framed (framing effect), and her primary pulmonologist concluded her main problem was impacted mucus (anchoring bias, ascertainment bias).
Within a few months, Multop was continually tired and very short of breath. Although he couldn’t understand her symptoms, her pulmonologist continued treating her for bronchiectasis and merely sent more sputum samples for analysis and tweaked her medications (more confirmation bias). Her cough got worse, and another chest X-ray suggested she had pneumonia again. Shortly thereafter, she collapsed in her doctor’s office and was rushed to the hospital where she was diagnosed as suffering from cardiogenic shock caused by congestive heart failure.
What to Do If You’re a Victim of Serious Diagnostic Errors
Fortunately, the patient in the case described in the Washington Post article and this blog post survived. However, fifty percent of all patients in cardiogenic shock do not. Moreover, many other patients suffer needless tests, invasive procedures, prolonged illnesses, and fatalities because of diagnostic errors.
As experienced Miami medical malpractice attorneys, we’re all too familiar with the devastating effects of misdiagnoses. We’ve helped many victims of misdiagnosis and failure to diagnose serious medical conditions, such as tumors, cancer, heart attacks, strokes, aneurysms, life-threatening infections, abscesses, intestinal perforations, organ injuries, deep vein thromboses (DVT), pulmonary emboli (PE), meningitis, encephalitis, ulcers, kidney disease, appendicitis, and other conditions requiring immediate treatment.
We understand that doctors and other health care providers are human and as such, make errors in their decision-making processes; however, when those errors are not corrected, when misdiagnoses and failure to diagnose a serious medical condition results in harm to a patient, we are committed to holding the doctors, other health care providers, and/or health care organizations accountable for their negligence.
Our medical malpractice lawyers endeavor to leave no stone unturned and use every lawful resource at our disposal to prove a client’s case. We feel a deep sense of responsibility to each client because we know that if someone comes to us for help, they have suffered a terrible loss and deserve answers, all the compensation the law will allow, and justice.
If you or a loved one has been injured by a diagnostic error, please contact the experienced Miami medical malpractice attorneys of Boyers Law Group for a free consultation about your legal rights and our commitment to seeking justice for you. We can be reached by phone at 800.545.9100 or online by submitting the “Tell Us What Happened” form on our website.
Boodman, S. G. (2019, Nov. 23). Her lungs seemed to be a mess. But the problem that nearly killed her lay elsewhere. The Washington Post.
National Academies of Sciences, Engineering, and Medicine. (2015). Improving diagnosis in health care. Washington, DC: The National Academies Press.
Society to Improve Diagnosis in Medicine. (2019). What is diagnostic error?
The Joint Commission. (2016, Oct.) Cognitive biases in health care. Quick Safety.
U.S. Department of health and Human Services. (2015, June). Anchoring bias with critical implications. https://psnet.ahrq.gov/web-mm/anchoring-bias-critical-implications