How much harm is caused by misdiagnoses in the Emergency Room and other clinical settings?
A recent report from the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence estimates that 795,000 Americans per year die or are permanently disabled after being misdiagnosed (371,000 patients die and 424,000 are permanently disabled). Missed stroke diagnosis is the #1 cause of these poor outcomes. Although estimates of misdiagnoses vary widely, this new research provides a clearer picture of the problem.
The Johns Hopkins Armstrong Institute Center for Diagnostic Excellence and partners from the Risk Management Foundation of the Harvard Medical Institutions performed the first rigorous national estimate of permanent disability and death from diagnostic error.
Vascular events, infections and cancers account for 75% of serious harms. The study found only fifteen diseases account for 50.7% of the total serious harms. The top five conditions causing the most frequent and serious harm account for 38.7% of total serious harm. These conditions have been identified as stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer. The top cause of serious harm from misdiagnosis was stroke, which was missed in 17.5% of cases. The overall average error rate across all diseases was estimated at 11.1%, but the rate can range from a low of 1.5% for heart attack to as high as 62% for spinal abscesses.
It has been said that doctors look for horses, not zebras. This means that doctors are looking for the simplest and most common explanation for the symptoms presented by their patients. Although this approach may allow them to treat many patients in an efficient manner, it leaves the “zebras” – those with unusual conditions – to potentially receive improper treatment.
When I was first diagnosed with heart failure that led to a heart transplant, it was not a straight line from my symptoms to a diagnosis. Although I had a pre-existing heart condition, Hypertrophic Cardiomyopathy (HCM), my cardiologist and family physician had different explanations for my shortness of breath. When I started gaining water weight, my cardiologist suggested that I might feel better if I lost weight. When I couldn’t breathe and developed a cough, my family doctor thought I had pneumonia. It took a trip to the Emergency Room to be diagnosed with Congestive Heart Failure (CHF.) However, the doctors at my local small-town hospital did not have a clear treatment plan for my care.
I was fortunate enough to be within driving distance of the Cleveland Clinic, and they provided me with an accurate diagnosis of my condition and prepared a thorough plan. On my visit to Cleveland, I learned more about my condition than I had known throughout my life, and they educated me on my treatment options, including the possibility of a heart transplant. I would not be alive today if I had not sought a second opinion.
If you have seen a physician and feel that your diagnosis or plan of care is not adequate, consider seeking a second opinion. The quality of medical care varies based on what medical center you choose. There are many “centers of excellence” that focus on specific health conditions. A quick internet search for one of these centers that specializes in your condition might just save your life.
Dawn Levitt, Author 
I am fortunate that I knew I had congestive heart failure only because Jo Joe had died from it and my symptoms were identical. Your dad kept telling me in Hawaii that my bathing suit was too tight. I told him I was full of fluid, as Jo Joe was. Once home and in the hospital with that diagnosis, I lost 70 pounds of fluid.
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I’m glad that you were able to get an accurate diagnosis and appropriate treatment.
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