Diagnostic errors have emerged as a pressing public health problem. Studies report that thousands of patients die or are permanently disabled every year due to diagnostic errors. While outsourcing medical transcription helps physicians focus better on their patients during appointments, errors in diagnosis can occur due to various reasons. According to a new analysis of national data from John Hopkins Medicine, diagnostic errors result in nearly 800,000 Americans dying or facing permanent disability annually across all clinical settings, including hospitals and clinics.
Diagnostic errors often arise from a mix of clinician biases and systemic issues in healthcare, according to the Agency for Healthcare Research and Quality (AHRQ). Missed or delayed diagnoses, especially for conditions like cancer, are a major reason for malpractice claims. Research into these errors is frequently based on closed malpractice cases in primary care, pediatrics, emergency medicine, and surgery. Poor teamwork and communication among clinicians are common factors for diagnostic mistakes in emergency and surgical settings. Lack of reliable systems for managing outpatient care-like handling urgent patient calls or ensuring test result follow-ups—further raise the risk of diagnostic errors.
Let’s take a look at the common causes of diagnostic errors and effective strategies for prevention.
Why Diagnostic Errors Occur
There are different types of diagnostic errors that can occur due to various reasons. Different types of diagnostic errors include:
- Misdiagnosis or incorrect diagnosis
- Missed diagnosis – completely failing to identify a present condition
- Delayed diagnosis – diagnosing a condition too late)
- Failure to recognize a related condition
- Missed complications – failing to recognize complications arising from a diagnosed condition
- Communication errors – poor communication between healthcare providers or between the provider and patient
Many factors can cause diagnostic errors:
- Flaws in clinical reasoning: Diagnostic biases or inaccurate beliefs affect decision-making. Physicians often rely on heuristics (“rules of thumb”) to reach a provisional diagnosis, especially when the patient has common symptoms. Cognitive biases include:
- Availability heuristic – Diagnosis of current patient biased by experience with past cases or referring to what comes to mind most easily
- Anchoring heuristic – Sticking with a diagnosis. For instance, when a patient does not respond to treatment, this type of bias would lead the physician to order a stronger dose or a different formulation of a previously prescribed medication instead of considering another diagnosis
- Framing – Assembling elements that support a diagnosis
- Blind obedience – Relying on another physician’s opinions, where an agreement is reached based on an authoritative source (such as laboratory and imaging test results) without adequate examination.
- Omission bias – Placing excessive emphasis on avoiding the adverse effects of a therapy, which leads to under-utilization of a beneficial treatment.
- Communication problems: Communication breakdowns are the most common causes of medical errors. Whether verbal or written, these issues can arise in a medical practice or a healthcare system and can occur between a physician, nurse, healthcare team member, or patient. Poor communication can result in diagnostic errors.
- Errors related to testing: Diagnostic errors in the testing process can be classified as preanalytic, analytic, and postanalytic. Preanalytic errors refer to problems with test selection, ordering, and specimen collection. Analytic errors refer to problems performing a clinical laboratory test. Postanalytic errors include problems with interpreting tests, reporting. and use of test results to make a diagnosis.
- Lack of reliable systems for common outpatient clinical situations: The AHRQ points out that lack of proper mechanisms for triaging acutely ill patients by telephone and following up on test results, also increases the chances of diagnostic error. Errors leading to misdiagnosis included inadequate documentation, faulty triage, and lack of protocols for handling telephone calls.
- Time constraints: Limited time with patients during appointments can result in rushed assessments and potential oversights. When physicians have only limited time to assess patients, it can lead to rushed decisions and potentially overlooking crucial information, increasing the likelihood of misdiagnoses or delayed diagnoses. This is often due to high patient volumes within a limited timeframe, leading to hurried evaluations and missed critical details. Medical transcription services can help to a certain extent by allowing physicians to focus on the patient rather than on entering information into the EHR.
- Overconfidence: Overconfidence is a risky trait in medicine, particularly in fields like emergency medicine, where patient outcomes depend on accurate and timely decisions. A study published in February 2024 (Adv Med Educ Pract) that looked into the possibility of a relationship between overconfidence, time-on-task, and medical errors, noted that overconfidence occurs when physicians overestimate their abilities, believing they perform better than they actually do. This can lead to diagnoses based more on personal opinion than on sufficient patient data. Instead of relying on relevant and reasonable information, overconfident individuals tend to trust their instincts.
- “The VIP Syndrome”: Researchers also highlight the VIP Syndrome as a reason for diagnostic errors. The VIP Syndrome is when the physician is intimidated or is unwilling to recommend things which may be unpleasant for their patient. This may lead them to prioritize special treatment or expedite care, potentially leading to diagnostic errors by rushing through assessments, overlooking crucial details, or ordering unnecessary tests, all in an attempt to please the patient. This can potentially cause misdiagnoses and compromise the quality of care.
Preventing Diagnostic Errors
Measures to prevent diagnostic errors include Improve clinician training, evaluate physician workloads and develop more accurate diagnostic tools and techniques. According to research published in JAMA Internal Medicine in January 2024, this could include using AI to evaluate patients, select the most appropriate tests and reduce delays. However, the study cautions that care must be taken to ensure the models are performing correctly without introducing errors or widening health disparities.
“In the end, helping physicians become better diagnosticians means coaching and training physicians, and helping physicians clearly explain diagnoses to patients,” says the paper’s first author, Andrew Auerbach, MD, MPH. “I suspect AI will help with many tasks, but we still have work to improve communication between patients and healthcare team members to fully advance the field,” he notes (source: UCSF).
Outsourcing Medical Transcription Can Help
Partnering with a medical transcription company is a viable strategy to deal with EHR-related documentation concerns and prevent missed diagnosis due to reduced time that physicians have with their patients at the appointment. Professional transcriptionists can ensure clear and accurate documentation, which can play a crucial role in minimizing diagnostic errors by providing a comprehensive record of a patient’s medical history, symptoms, examination findings, and test results. This allows healthcare providers to make informed decisions based on complete information, thus reducing the risk of misinterpretations or overlooking vital details that could lead to incorrect diagnoses.
