MISSED AND DELAYED DIAGNOSIS, STUDY OF MALPRACTICE CLAIMS
keywords, medical cancer, medical malpractice, missed diagnosis, delayed diagnosis, medical malpractice lawyer, claim, medical malpractice lawyer, New Jersey, New York.
The abstract studies the incidence of missed diagnosis, primarily focusing on
cancer . Gandhi, Missed and delayed diagnoses
in the ambulatory setting: a study of closed malpractice claims, Ann Intern Med.
2006 Oct 3;145(7)I12.
BACKGROUND: Although missed and delayed diagnoses have become an important
patient safety concern, they remain largely unstudied, especially in the
outpatient setting. OBJECTIVE: To develop a framework for investigating missed
and delayed diagnoses, advance understanding of their causes, and identify
opportunities for prevention. DESIGN: Retrospective review of 307 closed
malpractice claims in which patients alleged a missed or delayed diagnosis in
the ambulatory setting. SETTING: 4 malpractice insurance companies.
MEASUREMENTS: Diagnostic errors associated with adverse outcomes for patients,
process breakdowns, and contributing factors. RESULTS: A total of 181 claims
(59%) involved diagnostic errors that harmed patients. Fifty-nine percent (106
of 181) of these errors were associated with serious harm, and 30% (55 of 181)
resulted in death. For 59% (106 of 181) of the errors, cancer was the diagnosis
involved, chiefly breast (44 claims [24%]) and colorectal (13 claims [7%])
cancer. The most common breakdowns in the diagnostic process were failure to
order an appropriate diagnostic test (100 of 181 [55%]), failure to create a
proper follow-up plan (81 of 181 [45%]), failure to obtain an adequate history
or perform an adequate physical examination (76 of 181 [42%]), and incorrect
interpretation of diagnostic tests (67 of 181 [37%]). The leading factors that
contributed to the errors were failures in judgment (143 of 181 [79%]),
vigilance or memory (106 of 181 [59%]), knowledge (86 of 181 [48%]),
patient-related factors (84 of 181 [46%]), and handoffs (36 of 181 [20%]). The
median number of process breakdowns and contributing factors per error was 3 for
both (interquartile range, 2 to 4). LIMITATIONS: Reviewers were not blinded to
the litigation outcomes, and the reliability of the error determination was
moderate. CONCLUSIONS: Diagnostic errors that harm patients are typically the
result of multiple breakdowns and individual and system factors. Awareness of
the most common types of breakdowns and factors could help efforts to identify
and prioritize strategies to prevent diagnostic errors.
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Profile
Howard Gutman is a New Jersey attorney based in Parsippany, New Jersey who has handled numerous legal claims involving pulmonary tumors. A member of the board of directors of a leading cancer support group and a caregiver, he is the author of the new book Lung Cancer and Mesothelioma. In his legal capacity, he has appeared on Good Day New York, spoken at the National Press Club and been interviewed by NBC Nightly News.
Keywords, cancer, medical malpractice, missed diagnosis, delayed diagnosis, medical malpractice lawyer, claim, medical malpractice lawyer, New Jersey, New York.