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Strategies to avoid diagnostic errors


Diagnostic errors are the third leading cause of death. One expert shares strategies for reducing misdiagnosis.

By the numbers, it’s estimated that every single one of us will encounter a serious diagnostic error over our lifetimes. Gordon Schiff, M.D., who studies medical errors, seems to have already surpassed his allotment.

Dr. Schiff, who was slightly out of breath when he spoke with Dermatology Times, says he suffers from an unusual form of pneumonia that was misdiagnosed by multiple doctors. It took eight weeks to get a correct diagnosis.

What goes wrong when this kind of thing happens? Plenty, says Dr. Schiff, who discussed medical errors in an interview before his presentation about misdiagnoses at the summer meeting of the American Academy of Dermatology in Boston.

“Diagnosis errors are common, often not even recognized, and there is a lot of ground for improvement on multiple fronts,” says Dr. Schiff, who’s associate director of the Center for Patient Safety Research and Practice at the Brigham and Women's Hospital Division of General Medicine, safety director at the Harvard Center for Primary Care Academic Improvement Collaborative, and associate professor of Medicine at Harvard Medical School

Indeed, Johns Hopkins University researchers estimated in a study last May1 that medical errors as a whole account for 10% of all deaths in the United States, making them the third leading cause of death.

The world of skin care is no stranger to diagnosis errors, Dr. Schiff says.

“It’s something that’s probably obvious to all the dermatologists every day,” he says. “They’re getting a lot of patients coming from primary care doctors who are misdiagnosed: I’m calling things acne; they’re saying it’s more serious. I’m saying something is cancer; they’re saying it’s not.”

NEXT: What to do?


What to do?

Dr. Schiff points to two key strategies:

Situational awareness. To accomplish this, worry about what can go wrong, develop ways to prevent errors, and be open about failures.

To that end, Dr. Schiff calls for an end to the conspiracy of silence around diagnosis mistakes. There needs to be more error reporting so physicians can learn from each other, he says, and gain more awareness of conditions that are frequently misdiagnosed. “What are the pitfalls,” he says, “the traps that people frequently fall into?”

READ: Using dermoscopy to enhance diagnostic accuracy

Create a safety net to make sure that there are opportunities to notice and repair errors. To do this, take advantage of the power of technology to automate processes and ease burdens on staff.

Unfortunately, Dr. Schiff says, technology is often a hindrance: “Systems are clumsy to learn, they’re distracting, and there’s lot of potential for unintended consequences.”

As for Dr. Schiff himself, he didn’t let his own misdiagnosis slip quietly into the past. Instead, he tried to get information about the error back to his primary-care physician. But he didn’t seek a confrontation. “The idea is not to fight,” he says. “The idea is to improve.”

Disclosure: Dr. Schiff reports grants/research funding from MedAware.


1. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016;353:i2139.

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