Nearly 800,000 Americans Are Permanently Disabled Or Die Annually From Misdiagnosis: A study entitled Burden of serious harms from diagnostic error in the USA published in the medical journal BMJ Quality & Safety in July 2023 reported: “An estimated 795 000 Americans become permanently disabled or die annually across care settings because dangerous diseases are misdiagnosed. Just 15 diseases account for about half of all serious harms, so the problem may be more tractable than previously imagined … The 15 dangerous diseases accounted for 50.7% of total serious harms and the top 5 (stroke, sepsis, pneumonia, venous thromboembolism and lung cancer) accounted for 38.7%.”
An estimated 371,000 people die every year following a misdiagnosis, and 424,000 are permanently disabled. The lead author of the study stated, “We focused here on the serious harms, but the number of diagnostic errors that happen out there in the U.S. each year is probably somewhere on the order of magnitude of 50 to 100 million. If you actually look, you see it’s happening all the time. The risk level just walking through the door in the doctor’s office that something horrible is going to happen to you because of a diagnostic error is actually quite low.”
For the minority of people who do walk into a doctor’s office with serious, potentially fatal conditions, the study found the risk of death associated with misdiagnosis is 4% and the risk of severe disability 11%. Being a woman or a person of color increases chances of misdiagnoses by 20% to 30%.
The study found that cognitive error by the doctor is the overwhelming reason for misdiagnosis: doctors may make poor diagnostic decisions because the signs of the disease are atypical or the symptoms are too common and not frequently associated with a severe disease.
An assistant professor of pharmaceutical and health economics at the University of Southern California, who did not participate in the study, stated, “On the one hand we could be saving a hundred or more billion dollars by accurately diagnosing. And then on the back end, if we get this problem right, then instead of a $22 trillion GDP, we might have a $24 trillion GDP just because everybody’s getting the care that they need.”
A study published in 2005 that analyzed one hundred cases of diagnostic error involving internists that were identified through autopsy discrepancies, quality assurance activities, and voluntary reports found that system-related factors contributed to the diagnostic error in 65% of the cases and cognitive factors in 74%. The most common system-related factors involved problems with policies and procedures, inefficient processes, teamwork, and communication. The most common cognitive problems involved faulty synthesis: the most common cause was the failure to continue considering reasonable alternatives after an initial diagnosis was reached. Other common causes included faulty context generation, misjudging the salience of findings, faulty perception, and errors arising from the use of heuristics (heuristics are mental shortcuts that allow people to solve problems and make judgments quickly and efficiently). Faulty or inadequate knowledge was uncommon.
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