Study Shows that Doctors Hurt Patients by Making Simple Mistakes

By Linda Orlando

Researchers in a study published in the Annals of Internal Medicine on Monday said that when doctors make basic errors such as ordering tests too late or not creating proper follow-up plans, the result can be patients being hurt rather than helped. The study reviewed 307 medical malpractice claims, 181 of which involved alleged diagnostic errors that ended up with patients being harmed. Most of the cases reviewed dealt with various types of cancer, and 60% of the patients were hurt by the errors.

The study reviewed random samples of claims from four malpractice insurance companies in the United States between 1984 and 2004. Researchers ignored the outcomes of the claims, focusing just on the facts presented by patients and medical records. Nearly 60% of all the cases resulted in serious harm to the patient, and 30% resulted in death. All claims involved missed or delayed diagnoses, mostly in doctors’ offices by primary care physicians. More than half of those missed diagnoses involved cancer, and most of the overlooked tests in question were biopsies.

Researchers said that although most claims involved several factors, the major ones involved failure to order appropriate diagnostic tests (100 cases); failure to create an appropriate follow-up plan for a patient (81); failure to perform an adequate physical exam or obtain an adequate history (76); and incorrect interpretation of diagnostic tests (67). The leading factors that contributed to these errors included failures in judgment (79%); vigilance or memory (59%); lack of knowledge (48%); patient-related factors (46%); and handoffs (20%).

Dr. Tejal K. Gandhi, the lead author of the study and director of patient safety at Brigham and Women’s Hospital in Boston, said the results of the study show that doctors could benefit from help with making decisions, such as more use of electronic records, better algorithms for making evaluations, and employing nurse practitioners to be sure follow-up care actually takes place. "I don’t want to say that it’s not the physician’s responsibility," Gandhi said. "We think there could be tools to help physicians make these decisions better."

Doctors not involved with the study said that the findings serve to point out the fact that both doctors and patients should err on the side of caution when considering diagnostic tests, keeping detailed records, and paying attention to follow-up. Dr. Edward Langston, chair-elect of the board of the American Medical Association, said that in recent years, doctors have become more aggressive in terms of ordering screening tests such as biopsies, mammograms, and colonoscopies, even when a patient shows no symptoms.

But the results of the study point out the importance of patients paying close attention to their own care. Patients need to voice their own opinions, ask questions, do their own research, and bring loved ones or friends with them to appointments to help process information and ask questions.