Missed, and Mis-Diagnoses

There was an excellent article written by Dr. Jerome Groopman, of Beth Israel Deaconness Medical Center, in today’s Boston Globe, about the causes of medical misdiagnoses. When mis-, or missed, diagnoses occur, they can be deadly. The problem, writes Dr. Groopman, often stems from rigidity in the way doctors think about the symptoms presented by their patients. Dr. Groopman identifies three common errors made by physicians: (1) attribution errors; (2) anchoring; and (3) confirmation bias.

Attribution errors is described as reaching a diagnosis too quickly on the basis of a stereotype about the patient (an example would be a fit, 30 year old, whose chest pains are dismissed too quickly as muscular, when they are in fact heart-related, because of the doctor’s notion that the patient is too young and healthy for a coronary). Anchoring is a phenomenon I have seen more than a few times in medical malpractice actions I’ve handled. Anchoring occurs when the original or subsequent doctors, become convinced that the original diagnosis was correct, before adequately considering other possible causes for the symptoms presented. Confirmation bias occurs when evidence that could be interpreted in various ways, becomes taken as proof of the original (mistaken) diagnosis. Dr. Groopman discusses medical errors due to misdiagnosis, further, on his blog site.

He prescribes education as the cure for attribution errors, anchoring, and confirmation bias. The medical profession is just beginning, he says, to focus on the problem of misdiagnosis. On that last point, I do not fully agree with Dr. Groopman. Better education is always beneficial, but before managed care pressured doctors into “by-the-numbers” medicine, the best doctors knew about the kind of thinking that produced correct diagnoses. It required time and attention. My late father-in-law, a well-respected internist for 50+ years, told me that the key to successful diagnosis had been summed up for him, unforgettably, in medical school: “listen to your patient, doctor – he’s giving you the diagnosis.”