As a Houston, Texas medical malpractice lawyer, I have noticed a recent trend in misdiagnosis of serious medical conditions both in primary care office settings and in emergency rooms.
In my experience, there is a patient safety problem arising from physicians overlooking or downplaying classic symptoms of serious cardiovascular conditions and instead settling on benign, incorrect diagnoses.
Risk factors for cardiovascular disease
Cardiovascular disease (also called heart disease) is a broad group of illnesses including four major diagnostic categories:
(1) Coronary heart disease, including myocardial infarction (heart attack), angina pectoris, heart failure, and coronary death
(2) Cerebrovascular disease, including stroke and transient ischemic attack (TIA)
(3) Peripheral artery disease, including intermittent or occasional leg cramps typically caused by an arterial obstruction
(4) Aortic atherosclerosis, and thoracic or abdominal aortic aneurysm
Medical statistics reflect that the majority of adults over age 60 are afflicted by some type of cardiovascular disease.
Symptoms of heart disease
For decades, there is been a major public awareness campaign on heart disease. Most people know to see a doctor or go to the emergency room if they experience chest pain, shortness of breath, or fainting.
There are many other textbook symptoms of different types of heart disease. You do not have to have every one of these symptoms to be at risk. Indeed, the symptoms vary from person-to-person. For example, men are more likely to have chest pain, but women are more likely to have a constellation of symptoms including chest discomfort, shortness of breath, nausea, and fatigue.
For heart disease caused by atherosclerotic or plaque conditions in the blood vessels, symptoms can include chest pain, tightness, pressure, and discomfort (angina); shortness of breath; unusual feeling in the legs or arms, including things like weakness, coldness, numbness, or pain; and pain in the jaw, throat, neck, upper abdomen, or back.
Heart disease can also be caused by rhythm disorders, which are also called abnormal heartbeats or heart arrhythmias. Symptoms of this illness can include tachycardia (rapid heartbeat), bradycardia (slow heartbeat), chest pain or discomfort, shortness of breath, lightheadedness, dizziness, and fainting.
Some people have heart disease caused by a weakened heart muscle, called dilated cardiomyopathy. This condition can have symptoms including being out of breath; swelling in the lower extremities (legs, ankles, and feet); irregular heartbeats; fatigue; and dizziness or fainting.
Medical malpractice for misdiagnosis
A June 2017 study published in The Joint Commission Journal on Quality and Patient Safety backs up my observation that doctors, physician assistants, and nurse practitioners are misdiagnosing cardiovascular disease. Researchers looked at over 3,400 closed medical malpractice claims involving patient allegations of misdiagnosis of cardiovascular disease. All of the claims involved outpatient general medicine or family medicine office or clinic practices.
The study concluded that, “Missed diagnosis of cardiovascular disease in the outpatient general medicine setting represents an important patient safety risk.”
Based on careful, methodical review of claims data, the researchers uncovered that primary care providers often overlooked a correct cardiovascular diagnosis in favor of less-dangerous conditions that may mimic a cardiovascular disease. These diagnoses include nonspecific chest pain, esophageal and gastrointestinal disorders, musculoskeletal pain, respiratory infections, chronic obstructive pulmonary disease (COPD), asthma, nonspecific shortness of breath, and nonspecific diagnoses that mimic myocardial infarction, coronary artery disease, and pulmonary embolism.
Of course, by misdiagnosing the condition, these healthcare providers put their patients at risk of serious injury and death by failing to treat their true cardiovascular condition.
It was also interesting to me that the study conclusions rebutted one of the most common complaints that health insurance and tort reform lobbyists make against medical malpractice lawyers. While these special interests claim that plaintiffs’ lawyers pursue frivolous malpractice cases, this recent study makes it clear that this is not the case.
Cardiovascular medical malpractice claims in outpatient settings occur predominantly in patients with typical risk factors of cardiac disease rather than in low-risk patients. In other words, primary care providers are missing classic, textbook symptoms of cardiovascular disease when making their misdiagnoses.
I join the study authors in recommending that healthcare providers consider a cardiovascular cause in patients with conditions or risk factors consistent with cardiovascular disease, before settling on some other diagnosis.
In short, I believe that the study advocates a return to the differential diagnosis process that all doctors are taught in medical school. Doctors are supposed to assess their patients’ symptoms and then come up with a mental or written list of potential medical conditions that could explain the symptoms. The only way a potential diagnosis should be removed from the list is through diagnostic testing, rather than taking shortcuts and discharging the patient with the wrong diagnosis.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. In 2017, H Texas magazine named him one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
