Evidence Matters

because science reporting and decision-making should be evidence-based

1 in 6 NHS Patients Is Misdiagnosed: BBC Scotland Investigation

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One in six patients in the NHS is misdiagnosed, according to an investigation by BBC Scotland. I’m surprised that this investigation into the extent of misdiagnosis in the NHS has not received more publicity. The figures being quoted are that 1 in 6 patients receives a misdiagnosis from a GP or a hospital although there are distinctions drawn about whether or not these misdiagnoses are relevant to the patient or the offered treatment that is offered to them, or leads to harm.

There is no compulsory, comprehensive system to collect these errors or to learn from them even though such errors may be enormously instructive for doctors and healthcare staff and might prevent much unnecessary suffering and even harm for patients.

Although this investigation was carried out in Scotland, the assumption is that it is similar throughout the UK and in other countries because no-one collates these data.

BBC: Action call over diagnosis errors.

BBC Radio Scotland programme: Morning Extra Investigation: Misdiagnosis

Times: One in six patients ‘given wrong diagnosis’.

One in six people who visits a hospital or GP surgery is given the wrong diagnosis, according to a group of experts in patient care.

The group has estimated that 15% of patients are given misleading information about their condition by doctors in the first instance.

Misdiagnoses are estimated to occur in up to 3m patient visits every year. The most commonly misdiagnosed illnesses include epilepsy, ovarian cancer, meningitis, dementia and osteoporosis.

Definitive statistics are unavailable because there is no mandatory reporting system in Scotland for cases of misdiagnosis.

Daily Telegraph: One in six NHS patients ‘misdiagnosed’.

Prof Graham Neale, of the Imperial Centre for Patient Safety and Service Quality at Imperial College London, who is carrying out research into cases of misdiagnosis in the NHS, said it was a problem that was not being adequately dealt with.

“There is absolutely no doubt that this is being under-reported,” he said. “But more importantly they are not being adequately analysed.

“Trainee doctors are too quick to judgment, that is one of the problems that we face.”

He added, however, that in many cases, the medical errors were rectified within 48 hours.

The experts drew on research published in the American Journal of Medicine that estimated that up to 15 per cent of all medical cases in developed countries were misdiagnosed.

As far as I can tell from a quick look around, the JAMA paper to which the Telegraph and BBC stories refer is: Diagnostic Error: next frontier for patient safety.

Update: @Murzee of EvidMed Group and gimpyblog of Gimpyblog suggest that the investigators may also have been referring to Overconfidence as a cause of diagnostic error in medicine.

In BBC summary:

Scotland’s chief medical officer Dr Harry Burns said: “In Scotland there are something like 15 million contacts with GPs each year and the vast majority of them end up with the right treatment.

“I can’t say it [misdiagnosis] is a major problem. It’s a huge problem for the individuals affected by it and clearly that’s unsatisfactory and clearly we have to do something about that – and that’s about learning and making sure that diagnostic techniques improve.”

In context in the programme, this didn’t seem as inappropriately complacent as it reads in the text. There was a fair amount of discussion of doctors’ apprehensions about admitting error and risk management. There seemed to be comparatively little discussion as to the impact on the lives of affected patients. To be fair, I’ve only listened to the programme once and should perhaps refrain from judgment until there is a rough way of categorising the discussions and timing them and judging their prominence in the programme.

I’d be interested if you’ve listened to the programme and what you feel about the facts and the cases that are presented. There was a striking lack of anger and an extraordinary level of understanding as to the difficulties of diagnosis from those who called into the programme.

Updates and corrections

Daily Mail: One in six patients ‘wrongly diagnosed by NHS doctors’.

After an opportunity to discuss this investigation, one recurrent concern is why should ‘heartsink’ patients (those with Medically Unexplained Symptoms) agree to accept ‘management’ protocols for frequent attenders if there is an indication that 1 in 6 patients is misdiagnosed?

Tweetmeme for Telegraph account has a number of commenters who perceive this as a problem that is local to the NHS – it isn’t. Unfortunately, the fragments of information relating to this issue are scattered throughout the programme rather than plainly stated, but both the investigation and the JAMA paper are clear that this is a problem that is common to all developed countries. This is emphatically not an NHS-specific issue, and it is no justification for those seeking to disparage the NHS as some sort of support for the present US healthcare system.

Related links

Action against Medical Accidents
National Patient Safety Agency
Scottish Patient Safety Alliance


Written by oatmealts

September 22, 2009 at 11:15 am

Posted in Uncategorized

Tagged with , ,

One Response

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  1. Sorry, I have come to this post late. Is there anywhere that I can find out more about the BBC Scotland programme now?
    Anne Marie


    December 16, 2009 at 8:51 pm

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