In the spirit of the ancient injunction “Physician, heal thyself,” medical professionals are converting bad practices into best practices by learning from their own mistakes.

A number of insurers and health care providers are studying malpractice suits and redesigning programs to avert future mistakes. Their main focus is on faulty diagnoses, which are the leading cause of such litigation. The stakes are very high.

According to Peter Pronovost, a patient-safety researcher at Johns Hopkins University, 40,000 to 80,000 hospitalized patients die annually due to diagnostic errors. And as the leading cause of malpractice suits – upwards of 40 percent of cases – such errors cost insurers $300,000 each, on average.

But tracking the sources of diagnostic error is far from simple. As malpractice claims data shows, most errors have more than a single cause – often involving at least three breakdowns, such as computer glitches and improper charting, in the hospital’s care process. Patients, too, are often at fault. They may wait too long before seeking care, skip tests, or fail to follow instructions. By pinpointing and quantifying the problems, systems can redesign procedures to avert the most frequent errors.

Women are Winners: Breast Cancer is Most Commonly Missed Diagnosis

Women stand to gain the most from this development, since the most common missed or delayed diagnoses occur in cases of breast cancer. Kaiser Permanente, the California managed-care system, spent 15 years identifying 320,000 abnormal mammograms and 420,000 abnormal biopsies. As a consequence, says breast cancer surgeon Susan Kutner, 450 Kaiser patients were correctly diagnosed with either an abnormal biopsy or a new or recurrent cancer. These patients “would not have been found if we did not bring them in proactively,” she says.

Learning from Mistakes: The Move to Digitize Medical Records

Another improvement spurred by the malpractice data-mining is the adoption of electronic medical record systems (EMRs). Studies show, for example, that if a primary care doctor and a specialist both get the same set of test results, each assumes the other will follow up – a mistake prevented by an electronic case monitor. EMRs also replace the notoriously bad handwriting of physicians and nurses, and they make patients’ records instantly retrievable through a variety of mobile electronic devices such as iPads.

Even so, says Pronovost, medicine often remains “a crapshoot and an odds game,” requiring system wide changes before major safety gains are possible. Patients or families concerned about personal injury or medical malpractice should consult with a knowledgeable lawyer.


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