MLMIC Insight: Inadequate Patient Assessments Contribute to Diagnostic Errors and Substandard Treatment

According to CRICO’s recent benchmark report, The Power to Predict: Leveraging Medical Malpractice Data to Reduce Patient Harm and Financial Loss, the likelihood of a medical professional liability (MPL) claim resulting in an indemnity payment increase 85% when an inadequate patient assessment contributes to an errant diagnosis or substandard treatment. The report analyzed lapses in the diagnostic process.

In MLMIC’s recent publication, The Scope: Medical Edition, we explore the causes of diagnostic errors that contribute to indemnity payments of one million dollars or more.  Our study found an allegation of diagnostic error in 35% of the claims we reviewed. Additionally, errors in diagnosis is listed at the top of ECRI’s “Top Ten Patient Safety Concerns” for 2020.

Our report, Million Dollar Claims: A Closer Look, reveals that diagnostic errors are commonly associated with inadequacies in:  history taking; physical examinations; ordering of diagnostic tests; notification of test results; referrals and consultations; and  follow-up. A misstep in any of these measures can lead to a potential allegation of diagnostic error which compromises patient outcome and safety.

The following recommendations are made to minimize your risk of liability exposure from a diagnostic error claim:

1. Ensure adequate time is provided for capturing medical, surgical, social, family, and medication histories. Obtaining the associated information will support the process of reaching an accurate diagnosis.
2. Perform a comprehensive physical examination. This initial assessment is critical to the diagnostic process.
3. Order diagnostic tests necessary to aid in patient assessment and reaching a final diagnosis.
4. Determine whether specialty consultation is needed.
5. Develop systems to ensure that patients follow through in seeing the recommended consultant and/or complete the necessary ordered tests; that test results are received, reviewed, and properly addressed. MLMIC’s Risk Management Tip #2 provides guidance on the tracking of consultations and test results.
6. Define the roles and responsibilities of the referring and consulting physicians. The lack of communication between providers may result in poor coordination of care. This may include a delay in diagnosis or treatment, the failure to order diagnostic testing or act upon abnormal test results, or the failure to prescribe appropriate medications. Clearly defining the roles and responsibilities of the referring and consulting physicians will promote safe and effective patient care. MLMIC’ Risk Management Tip #12 provides recommendations for promoting communication.

Overall, healthcare providers should be cognizant of the contributing factors leading to diagnostic errors which impact patient outcome. For additional information on managing diagnostic error, watch our Continuing Medical Education course High Exposure Liability: Errors in Diagnosis – Part 1 & Part 2.