Getting the Diagnosis Wrong

October 8, 2015 | The New York Times.

Last week a middle-aged woman came to my office because she had abdominal pain. This is a daily occurrence for doctors who work in general medicine, emergency departments or urgent care centers. There are days when the presence of abdominal pain seems as ubiquitous as the presence of oxygen, and this ubiquity can sometimes dull the sense of urgency. But every doctor knows that the list of possible causes of abdominal pain — what’s called the differential diagnosis — is as extensive as it is varied. It includes the common (acid reflux) and the rare (porphyria), and the benign (constipation) as well as the life-threatening (a tear in the aorta or intestine).

As I talked with my patient and examined her abdomen, my mind ran through this list, prioritizing what diagnoses seemed more likely while trying to keep in mind the more serious conditions that I couldn’t afford to miss. But the question remained in my head: Would I get the diagnosis correct?

Diagnostic accuracy is fiendishly difficult to measure precisely, but it is estimated that doctors get it wrong in one out of 10 to one out of 20 cases. Up until now, the focus of the patient safety movement has been on errors of medical treatment — incorrect medications or dosages, postoperative complications, hospital-acquired infections. But diagnostic errors — incorrect or delayed diagnoses — may be more common and potentially more deadly. The Institute of Medicine has taken up the subject, and its new report offers the chilling observation that nearly everyone will experience at least one diagnostic error in their lifetimes.

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Danielle Ofri’s newest book is What Doctors Feel: How Emotions Affect the Practice of Medicine. She is a physician at Bellevue Hospital and an associate professor of medicine at N.Y.U. School of Medicine, as well as editor-in-chief of the Bellevue Literary Review. She spoke on Deconstructing Our Perception of Perfection at TEDMED.

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