Wrong diagnoses are killing patients

[Guest guest]

http://www.newscientist.com/news/news.jsp?id=ns99994693

 

 

 

Wrong diagnoses are killing patients

19:00 18 February 04 Exclusive from New Scientist Print Edition.

Subscribe and get 4 free issues.

Many patients in intensive care units are being wrongly diagnosed,

according to a study in a UK hospital. Some are dying because doctors

fail to spot major conditions such as heart attacks, cancer and

pulmonary embolism. The reason, experts say, is not incompetence but

that so few post-mortems are now performed that doctors cannot learn

from their mistakes.

 

Fang Gao Smith, a consultant in intensive care medicine at Birmingham

Heartlands Hospital, and her team checked the accuracy of diagnoses by

comparing post-mortem results with patients' medical records. In 39 per

cent of cases, they found major problems had been missed.

 

The problem is not limited to one hospital, or to the UK. Gao Smith says

her findings are consistent with other studies done in Europe and the

US. She thinks doctors place too much faith in sophisticated scanners

when making diagnoses, and are failing to learn from their mistakes

because fewer and fewer autopsies are being done, both in the UK and the US.

 

" If we did more post-mortems it might be possible to save more people in

the future, " Gao Smith says. The decline needs to be reversed as a

matter of urgency, she says.

 

Other experts agree. " We have suspected that 30 per cent of diagnoses

may not be correct, " says James Underwood, a pathologist at the

University of Sheffield and president of the UK's Royal College of

Pathologists. " That's not to say doctors are not doing their jobs

properly. It's just that even with all the high-tech equipment we have

now, it's not always possible to make the correct diagnosis. "

 

 

Inappropriate treatment

 

 

The study also raises the question of how many other patients are being

misdiagnosed. Gao Smith says the frequent misdiagnoses in intensive care

units should set alarm bells ringing in other areas of medicine.

 

" It's not always possible to talk to intensive care patients. But they

are also scrutinised and monitored more than any other patients, so I'm

not sure we can say that they are more likely to suffer misdiagnosis. "

 

Gao Smith's study covered a three-year period. During this time, of 2213

patients treated in the Heartlands Hospital intensive care unit, 636

died. Just 49 post-mortems were done, and the results of 38 were

available to the team. Of these, only 17 diagnoses turned out to be

completely correct. In 15, major conditions had been missed, including

three undiagnosed heart attacks. In 10 of these cases, patients might

have survived if the diagnosis had been more accurate. Others suffered

unnecessarily because of inappropriate treatment.

 

 

Suspicious circumstances

 

In the UK, hospital post-mortems can only be done with the permission of

the deceased's family unless there are suspicious circumstances. Since

1991, the proportion of deaths in UK hospitals followed up by a

post-mortem has fallen from one in 10 to around one in 40 (see graphic).

The decline has accelerated in the past five years, following a scandal

over body parts being retained without families' permission at Alder Hey

Children's Hospital in Liverpool.

 

Doctors in the US are also worried about the decline in autopsies. In

1995, the National Center for Health Statistics stopped collecting

autopsy statistics, so authorities in the US do not even know if the

decline is continuing.

 

Another problem, Underwood says, is that some doctors are not keen to

encourage post-mortems for fear they might reveal that inappropriate

treatment had been given. " Some are frightened that families will sue. "

 

Journal reference: Critical Care (vol 7, issue 6)

 

Michael Day