Pop Quiz: what's the error rate of diagnosis in US healthcare?

Posted by Sten Westgard, MS

Can you guess just how bad US healthcare is at making the right diagnosis?

Is the error rate in the US related to diagnosis

• 5%?
• 10%?
• 6 to 17%?
• all of the above?

The answer, after the jump...

Of course, it's all of the above.

The Institute of Medicine, author of such infamous reports as Too Err is Human, has issued a new report entitled Improving Diagnosis in Health Care. In the summary, they note

• "A conservative estimate found that 5 percent of US adults who seek outpatient care each year experience a diagnostic error.
• Postmortem examination research spanning decades has shown that diagnostic errors contribute to approximately 10 percent of patient deaths
• Medical record reviews suggest that diagnostic errors account for 6 to 17 percent of hospital adverse events."

 These are sobering statistics. If we would convert them to a Sigma-metric, on the short term scale, these are Sigma's of 3.2, 2.8, and between 3.1 and 2.5. It's not a surprise that many people consider the US healthcare system to be a failure. By objective benchmarks, it is failing.

For the laboratory, I suppose there is an impulse to blame the clinician mostly for these diagnostic errors. But as I recall, labs have been claiming over and over that somewhere between 66% and 75% of medical decisions are being made on the basis of laboratory tests. So many of these diagnostic errors have some of their roots in our test results. Even if the clinician is misinterpreting a lab test in order to make the wrong diagnosis, we in the lab can't wash our hands of responsibility.

If we want to have any future at all where we're more than line workers in a number factory, we've got to step up and take responsibility for at least some of these diagnosis errors. And we certainly need to play a role in the solution.

The report is available as a free PDF download from the National Academies Press. (Imagine that, a monumental public good, directed by government and funded by the public, available to the public for free)