Pneumonia, Heart Failure Among Most-Missed Diagnoses

The most-frequent diagnostic errors are for common conditions seen by primary care doctors, including ailments such as pneumonia and heart failure that can lead to severe harm if not treated appropriately, a study found.

The misdiagnoses occurred most often during the doctor’s examination, including trouble getting a complete history from the patient, performing the physical exam and ordering tests, according to research published today in JAMA Internal Medicine. Other common misdiagnoses were for kidney failure, urinary tract infection and cancer.

The findings show that doctors miss or wrongly diagnose a wide range of conditions that can be harmful to patients’ health, said lead study author Hardeep Singh. To reduce the number of misdiagnoses, more needs to be done by doctors and hospitals to engage the patient in their own health care and to improve their access to physicians, he said.

“If we do it together with patients, providers and health care systems, we will have a much deeper impact of understanding and improving this problem,” Singh, chief of health policy and quality program at the Health Services Research and Development Center at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, said in a telephone interview today.

Researchers looked at the medical records of patients at a large urban Veterans Affairs facility and a private health care system to determine how often patients returned to doctors after a primary care visit.

190 Errors

The researchers focused on 190 errors in primary care visits between October 2006 and September 2007 that involved 68 unique conditions.

The most common were pneumonia at 6.7 percent, heart failure, 5.7 percent, kidney failure, 5.3 percent, cancer, 5.3 percent and urinary tract infections, 4.8 percent. Difficulty with diagnosing occurred not only during the initial patient exam, but with the patients themselves, failure of doctors to follow up and track tests and referrals.

“Given the range of conditions associated with diagnostic errors in this setting, disease-specific efforts to reduce these types of diagnostic errors are unlikely to be sufficient,” the authors wrote. “Thus, preventive interventions must focus on common contributory factors, particularly those that influence the effectiveness of data gathering and synthesis in the patient-practitioner encounter.”

Better follow up may help reduce errors, Singh said. One idea for doctors who aren’t certain of a patient’s condition would be to tell the person it may be one ailment but call back in a day or two if symptoms don’t improve or worsen because it could be something else, he said. This increases the chance that patients may actually call the doctor if they aren’t feeling any better, he said.

Another suggestion is to have a team-based approach in which a doctor, administrator and nurse work together to care for a patient so everyone is involved in the treatment, he said. That model is used at hospitals operated by Veterans Affairs.

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