Wrong diagnoses are killing patients with a 39 per cent error rate: Some are frightened that families will sue.

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Wrong diagnoses are killing patients

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

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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

 

 

 

 

 

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