According to recent studies, botched or delayed diagnoses are the most common, expensive, and deadly of all medical errors.
Researchers believe that around 12 million adults are the victims of a diagnostic error annually in United States in outpatient settings (doctors’ office or clinic visits, rather than hospitalizations). In American hospitals, diagnostic mistakes account for around 80,000 deaths each year.
The introduction of new technology into office, clinic, and hospital settings hasn’t dramatically reduced medical errors, as might be expected. In fact, some people believe it is has made matters worse.
Physicians can become overly reliant on computer screens, at the expense of evaluating patients sitting in front of them. Some electronic medical record software restricts narrative documentation and instead force doctors and nurses make multiple choices. The problem with this type of system is that no electronic system can account for all the variabilities inpatient anatomy and physiology.
This subject immediately makes my mind wander back to a significant stroke misdiagnosis case that we handled involving a hospital in suburban northeast Houston. The healthy, middle-aged patient had a sudden onset of severe headaches. He went to the emergency room three days in a row. Finally, on the third day, a physician assistant (PA) gave in to the request of the patient’s wife for a CT scan. All along, both the patient and his wife had been concerned that he was having a stroke.
That hospital’s electronic medical record system for ordering diagnostic radiographic studies, such as CT and MRI scans, didn’t allow the ordering doctor or provider to type in any narrative information about the reason for the exam. Radiologists call this the indication. The reason or indication is important because it helps to focus the radiologist’s attention on the correct areas of the scan, based on the reported clinical issues.
In this man’s case, the available multiple choices didn’t include an accurate description of the reason or indication for the CT scan order. Thus, the PA went with the least-incorrect option. The neuroradiologist interpreting the CT scan from a remote location had no idea that the scan had been ordered out of concern for potential stroke. Instead, she believed it was solely related to headache and conducted a more general review of the CT images.
According to our neuroradiology expert, the neuroradiologist misinterpreted the CT scan, which already had signs pointing to an impending stroke because of a condition that had been simmering for three days. Because of this misdiagnosis, the emergency room doctor made a clinical misdiagnosis of migraine headaches and discharge the patient home with painkillers.
A few hours later, the patient had a massive stroke at home and has never regained his full neurologic function. This man, with a significant chunk of his life ahead of him, will never be able to return to work or enjoy the athletic and physical activities that he had taken part of with his children before his misdiagnosis.
Yesterday, I deposed two trauma surgery critical care physicians in a Beaumont, Texas medical malpractice wrongful death case. Depositions are court proceedings where witnesses are sworn in by a court reporter, who transcribes an official transcript of questions and answers. The transcript can be read in court to the judge and jury.
The issue in that case involved a middle-aged man who was brought to a hospital emergency room after a high-speed car wreck. Undoubtedly, he had lots of medical issues to be dealt with because of the trauma, including multiple broken bones and ribs. Initially, these doctors were involved with trying to stabilize him so he could be taken to surgery.
In trauma situations, stabilizing a patient typically focuses on hemodynamic status. Doctors will often order intravenous (IV) fluids and blood products to replace lost volume and address low blood pressure. Sometimes medical therapy, in the form of vasopressors, is used to help support an adequate blood pressure.
Under intense deposition questioning, one of the trauma critical care surgeons gave target numbers for mean arterial pressure (a specific type of blood pressure measurement) that would indicate that it was safe to stop fluid resuscitation and vasopressors. After initially denying that the patient never met the criteria, he was forced to change his testimony when confronted with the truth of the medical records.
The record showed that this patient came in with traumatic injuries, improved with appropriate resuscitation treatment, and then took a deadly turn for the worse. Our medical expert concluded that the attending physicians were essentially on autopilot, not considering new information that should have captured their attention—things like a fever and critically elevated lactic acid levels, which can be signs of an infection.
Instead of adding the potential explanations of infection and sepsis to the differential diagnosis list and working them up, the two doctors chose to ignore them. They chose not to order basic tests, such as a blood or urine culture, or to order broad-spectrum antibiotic coverage to address a potential infection in a patient who was already recovering from traumatic injuries. In short, they unwittingly allowed the patient to die.
On autopsy, the pathologist identified a Serratia bacterial infection. Our experts believe that this infection caused sepsis, which triggered Adult Respiratory Disease Syndrome (ARDS) because of a lack of treatment.
If you’ve been seriously injured because of misdiagnosis in Texas, then contact an experienced, top-rated skilled Houston, Texas medical malpractice lawyer to discuss your potential case.
