Medical Errors - Friday's Progress Notes

Editor's Note

Studies have shown that diagnostic medical errors account for twice as many malpractice suits as any other type of error. They also are responsible for the most severe harm to patients.

Do these kind of errors get the attention they deserve? Many would say they do not.

There are a variety of underlying causes for these medical errors - anything from diagnostic fixation, lack of patient honesty, or poor patient-clinician relationships.

In this edition of Friday's Progress Notes I've assembled a collection of resources to shed some light on the prevalence of Med Errors and give you suggestions on how you can fight diagnostic and other errors in your practice.

We welcome your comments and feedback. Is there a topic you'd like to see covered in a future edition of Friday's Progress Notes? If you'd like to get in touch just click here to send us a message.

Resources

1. 1. Diagnostic Errors More Common, Costly And Harmful Than Treatment Mistakes
      In reviewing 25 years of U.S. malpractice claim payouts, Johns Hopkins researchers found that diagnostic errors — not surgical mistakes or medication overdoses — accounted for the largest fraction of claims, the most severe patient harm, and the highest total of penalty payouts.
      JOHNS HOPKINS MEDICINE
   2. DSM-5: How Reliable is Reliable Enough?
      It is important that our expectations of DSM-5 diagnoses be viewed in the context of what is known about the reliability and validity of diagnoses throughout medicine.
      AMERICAN JOURNAL OF PSYCHIATRY
   3. Overdiagnosis of mental disorders in children and adolescents
      While there is little research concerning overdiagnosis of child and adolescent mental disorders, first studies point to misdiagnosis of several mental disorders. Unintended overdiagnosis can occur due to use of heuristics, disregarding differential causes of observed behavior, misleading endorsement of symptoms by caregivers,
      or differential interpretation of diagnostic criteria by examiners.
      CHILD AND ADOLESCENT PSYCHIATRY AND MENTAL HEALTH
   4. How Reliable is the DSM-5?
      Throughout the controversies that surrounded the development and launch of the DSM-5 reliability has been a contested issue: the APA has insisted that the DSM-5 is very reliable, others have expressed doubts. Here I reconsider the issues: What is reliability? Does it matter? What did the DSM-5 field trials show?
      MAD IN AMERICA
   5. Reliability, Validity, and Classification Accuracy of the DSM-5 Diagnostic Criteria for Gambling Disorder and Comparison to DSM-IV
      The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the DSM-5 diagnostic criteria for Gambling Disorder. Second, to compare the DSM-5–DSM-IV on reliability, validity, and classification accuracy, including an examination of the effect of the elimination of the illegal acts criterion on diagnostic accuracy.
      JOURNAL OF GAMBLING STUDIES

6. Misdiagnosis or Comorbidity: Borderline Personality Disorder in a Patient Diagnosed With Bipolar Disorder
   Borderline personality disorder can commonly be confused with or misdiagnosed as bipolar disorder, largely because of the overlapping symptoms relating to affective instability (4). Some believe that bipolar disorder and borderline personality disorder are separate entities that, in some cases, can coexist (5), while others see them on a spectrum together (6). In the present case report, the patient was formerly diagnosed with bipolar disorder but later given the diagnosis of borderline personality disorder.
   AMERICAN JOURNAL OF PSYCHIATRY
7. Interviewer-Perceived Honesty Mediates Racial Disparities in the Diagnosis of Schizophrenia
   Interviewer perceptions of patient honesty are important contributors to disparities in the diagnosis of schizophrenia among African Americans, and may be reflective of poor patient-clinician relationships. Methods of facilitating a trusting relationship between patients and clinicians are needed to improve the assessment and treatment of minorities seeking mental health care.
   PSYCHIATRY SERVICES
8. Diagnostic Errors
   A diagnostic error emerges when a diagnosis is missed, inappropriately delayed or is wrong (2). Diagnoses can be completely missed (cancer missed despite symptoms), wrong (patients told they have one diagnosis when there is evidence of another) or delayed (abnormal test result suggestive of cancer, but no one has told the patient). There may be overlaps in these classifications.
   WORLD HEALTH ORGANIZATION (WHO)
9. Why Diagnostic Errors Don't Get Any Respect—And What Can Be Done About Them
   In this article I describe the reasons for the relative inattention to diagnostic errors in the field of patient safety. I also suggest some changes that would help elevate efforts to fight diagnostic errors to their rightful place among serious safety measures.
   HEALTH AFFAIRS
10. Problems for the Book of Problems? Diagnosing Mental Health Disorders Among Youth
    The lack of a “gold standard” in identifying youth psychological difficulties highlights the need for added research and consideration given to the divergent perspectives that are brought to the diagnostic evaluation of youth.
    CLINICAL PSYCHOLOGY