Doctors make misdiagnoses for all kinds of reasons — they might second guess themselves, or ignore contradictory symptoms — but the diverse errors produce common outcomes, and these can be tracked to produce better diagnoses in the future, a University of Minnesota report suggests.
If a patient suffers a stroke days after an emergency room visit for unexplained dizziness, for example, that probably means someone overlooked signs of the brain attack during the initial visit, said Dr. Andrew Olson, a U internal medicine and pediatric specialist.
Such "symptom pairs" can be identified by researchers through analysis of large medical claims data sets, Olson said, and can then be used to warn doctors of common situations in which diseases are misdiagnosed or overlooked.
"We can start to measure them and start to get better," said Olson, who co-authored a paper on the topic this month in the Journal of General Internal Medicine.
Physicians should review their practices and identify more symptoms pairs and types of misdiagnosis that can be tracked and potentially prevented, he said.
Doctors wouldn't have been as interested a few years ago, but changes in the profession and a 2015 Institute of Medicine (IOM) report have increased attention to misdiagnoses, he said.
"A few years ago, places were like, 'That's not our problem, that doesn't happen here.' "
The IOM report concluded that most people will encounter some kind of diagnostic error in their care at some point in their lifetime, and cited research showing that these errors contribute to 10 percent of deaths and 6 percent to 17 percent of adverse events in hospitals.
Olson's study proposes initial research targets, such as patients who suffer colon cancer within a year of screening, or tuberculosis infections that aren't identified until the autopsy of a patient who died.
The U has taken other steps to address diagnostic errors, including special training of pediatric residents that addresses the uncertainty they might feel when examining patients. Doctors often struggle to tell patients when they haven't arrived at a clear diagnosis, but Olson said there is an effective way to tell them "I don't know, but I'll be with you."
The U also has tested having day-shift doctors send notes to night-shift residents to alert them to the condition of their patients and whether their diagnoses were correct.
Jeremy Olson • 612-673-7744
