Most Americans will get a diagnosis that is wrong or delayed at least once in their lives, say medical experts examining a mostly understudied issue of patient safety.
Even though such an incorrect or late diagnosis can have tragic consequences, efforts to improve the quality and timeliness of diagnoses have, for the most part, been very limited, a report by the Institute of Medicine says.
Changes in an increasingly complex health care system in the U.S. may be making the problem worse, says the independent panel of experts that prepared the report for the U.S. government.
"Diagnostic errors are a significant contributor to patient harm that has received far too little attention until now," says Victor Dzau, president of the National Academy of Medicine, which oversees the Institute of Medicine.
"This latest report is a serious wake-up call that we still have a long way to go," he says.
Diagnosis has always been "a collaborative and inherently inexact process," the panel's report noted, and that can lead to missed or mistaken diagnoses as the process unfolds over time and across different health care settings.
"Diagnosis is a collective effort that often involves a team of health care professionals — from primary care physicians, to nurses, to pathologists and radiologists," says John R. Ball, head of the report committee and vice president emeritus of the American College of Physicians. "The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate, and a diagnostic error is not always due to human error."
Part of the problem in addressing the issue is data on diagnostic errors is hard to come by, and errors are often caught only after the fact and after disastrous consequences, the report authors point out.
Those consequences can include trauma to the patient or their loved ones, missed treatment opportunities and unnecessary treatments, they said.
Improvement in diagnosis accuracy will need more effective teamwork and cooperation among health care professionals, patients and the families, the authors suggest, along with enhanced training for health care professionals and greater emphasis on spotting diagnosis errors in clinical practice and learning from them.
"Therefore, to make the changes necessary to reduce diagnostic errors in our health care system, we have to look more broadly at improving the entire process of how a diagnosis [is] made," Ball says.