Wrong diagnoses are killing patients

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Wrong diagnoses are killing patients

19:00 18 February 04

Many patients in intensive care units are being wrongly diagnosed, according

to a study in a UK hospital. Some are dying because doctors fail to spot

major conditions such as heart attacks, cancer and pulmonary embolism. The

reason, experts say, is not incompetence but that so few post-mortems are

now performed that doctors cannot learn from their mistakes.

Fang Gao , a consultant in intensive care medicine at Birmingham

Heartlands Hospital, and her team checked the accuracy of diagnoses by

comparing post-mortem results with patients' medical records. In 39 per cent

of cases, they found major problems had been missed.

The problem is not limited to one hospital, or to the UK. Gao says her

findings are consistent with other studies done in Europe and the US. She

thinks doctors place too much faith in sophisticated scanners when making

diagnoses, and are failing to learn from their mistakes because fewer and

fewer autopsies are being done, both in the UK and the US.

" If we did more post-mortems it might be possible to save more people in the

future, " Gao says. The decline needs to be reversed as a matter of

urgency, she says.

Other experts agree. " We have suspected that 30 per cent of diagnoses may

not be correct, " says Underwood, a pathologist at the University of

Sheffield and president of the UK's Royal College of Pathologists. " That's

not to say doctors are not doing their jobs properly. It's just that even

with all the high-tech equipment we have now, it's not always possible to

make the correct diagnosis. "

The study also raises the question of how many other patients are being

misdiagnosed. Gao says the frequent misdiagnoses in intensive care

units should set alarm bells ringing in other areas of medicine.

" It's not always possible to talk to intensive care patients. But they are

also scrutinised and monitored more than any other patients, so I'm not sure

we can say that they are more likely to suffer misdiagnosis. "

Gao 's study covered a three-year period. During this time, of 2213

patients treated in the Heartlands Hospital intensive care unit, 636 died.

Just 49 post-mortems were done, and the results of 38 were available to the

team. Of these, only 17 diagnoses turned out to be completely correct. In

15, major conditions had been missed, including three undiagnosed heart

attacks. In 10 of these cases, patients might have survived if the diagnosis

had been more accurate. Others suffered unnecessarily because of

inappropriate treatment.

In the UK, hospital post-mortems can only be done with the permission of the

deceased's family unless there are suspicious circumstances. Since 1991, the

proportion of deaths in UK hospitals followed up by a post-mortem has fallen

from one in 10 to around one in 40 (see graphic). The decline has

accelerated in the past five years, following a scandal over body parts

being retained without families' permission at Alder Hey Children's Hospital

in Liverpool.

Doctors in the US are also worried about the decline in autopsies. In 1995,

the National Center for Health Statistics stopped collecting autopsy

statistics, so authorities in the US do not even know if the decline is

continuing.

Another problem, Underwood says, is that some doctors are not keen to

encourage post-mortems for fear they might reveal that inappropriate

treatment had been given. " Some are frightened that families will sue. "

Journal reference: Critical Care (vol 7, issue 6)

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