A recent study from a team of Johns Hopkins University School of Medicine researchers have found that more than one in four intensive care unit (ICU) patients who died suffered some degree of misdiagnosis.
While the number of deaths (over 40,000) is quite sizeable, because of the variability of the cause of death, this issue has received little study. The lead author of the report, Bradford Winters, M.D., Ph.D., comments that “Our study shows that misdiagnosis is alarmingly common in the acute care setting.”
The study found that 28 percent of patients examined in autopsy reports had some undiagnosed condition when they died. Troublingly, eight percent suffered from an undiagnosed condition that could have caused their death or been a contributing factor.
The researchers had to make various assumptions to extrapolate some of their findings, due to the fact that a substantial proportion of deaths do not have autopsies performed, meaning there would be no way in which to determine if the patient had suffered any misdiagnosed conditions.
Four Types Missed Most Often
The report found that four types of misdiagnosed conditions made up the majority of the ailments missed by doctors. They were ” heart attack; pulmonary embolism, artery blockage in the lungs; pneumonia; and aspergillosis, a fungal infection that most commonly affects individuals with a weakened immune system.”
Ironically, the study concluded that patients in an “ICU face up to a twofold risk of suffering a potentially fatal diagnostic mistake.” At first, it may be difficult to understand how a patient in an ICU, where they are subject to constant and intense monitoring, could be more likely to die of some misdiagnoses than patients in the general hospital population until you realize the complex nature of a modern hospital ICU.
A critical care physician has to supervise numerous patients in a hectic environment, often having to make time-critical decisions under less than ideal circumstances. Dr. Winters points out that an ICU doctor may receive “7,000 or more pieces of information” in a day.
Hospitals need to devise systems to ensure that the doctors have the right information at the right time, so that vital information is not lost in the noise generated by those 7,000 pieces of information.
A Problem Beyond the Deaths
The study alluded to the fact that even when the misdiagnosis does not lead to death, it is not without costs, both to the patient directly and to the health care system as a whole.
When a patient is misdiagnosed, even if it is relatively minor, it may result in their receiving treatment or a procedure that was unnecessary or unhelpful, none of which is free. They may be forced to remain in the hospital for a longer period, remain sicker, and take longer to fully recover.
While it is always difficult to second-guess a doctor (they are supposed to be the expert) your awareness of the care you are receiving is your best defense to malpractice by misdiagnosis. The most worrying aspect of the finding is that when you are in an ICU, you are least likely to be able to police your own medical treatment.