As we detailed in this week’s cover story, six-year-old Claudialee Gomez-Nicanor died from complications related to her type 1 diabetes. When she arrived at the hospital after a night of nausea and fatigue, her blood sugar was five times the normal level. Her body had needed insulin to process that glucose. but she did not get insulin because her doctor, pediatric endocrinologist Arlene Mercado, appeared to have diagnosed her with type 2 diabetes, which is not as urgent and can be fixed through diet, exercise, and medication.
The misdiagnosis was both tragic and confounding. Type 2 diabetes is extremely rare in kids under 10. Children’s diabetes expert Craig Alter testified in court that if a six-year-old has diabetes, there’s a “99.99 percent” chance it’s type 1. The jury found Mercado 100 percent liable for Claudialee’s death.
The case speaks to a greater trend. With all the national focus on health care policy and making sure everyone has access to treatment, it’s easy to forget about one of the industry’s most fundamental yet complicated issues: accurate diagnosis.
In April, Johns Hopkins release a study that found that misdiagnosis accounted for the largest share of legal payouts among all medical malpractice claims.
The researchers analyzed more than 350,000 malpractice cases, stretching back 25 years. More than a third of the total payouts stemmed from misdiagnosis.
“This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States,” lead researcher David Newman-Toker said in a statement. “These are frequent problems that have played second fiddle to medical and surgical errors, which are evident more immediately.”
Misdiagnoses, in contrast, are “difficult to measure and keep track of.” There’s often a time gap between the doctor’s mistake and the patient’s turn-for-the-worse, which can make it hard to trace the cause.
Other times, the link can be easy for jurors to see.
There was the case of doctors missing a man’s brain aneurysm that went on to cause a massive stroke. Another of a radiologist not seeing the fracture on the x-ray of a man’s hand.
There was the woman who died from cancer after her doctor told her the lump on her breast was not cancerous. And then there was the man who quit his job and prepared for his death after his doctor told him he had fatal pancreatic cancer, only to later find out that he actually had the treatable non-Hodgkin’s lymphoma.
Doctors are humans, of course, prone to the flaws the rest of us have. Which is why the misdiagnosis issue is so challenging.
As the Wall Street Journal reported in 2006, some hospitals are trying new methods “to help doctors by offering an array of possible diagnoses they might not have considered or prompting them to perform appropriate tests on patients with certain symptoms.” For instance, doctors type in a patient’s symptoms into a computer system that shows them 10 or possible diagnoses.
These “decision-support systems,” one doctor explained to the paper, “help doctors avoid falling victim to ‘premature closure’–the tendency to focus on one diagnosis that seems to explain all of the symptoms, then stop considering other possibilities.”
Premature closure is what cost Claudialee her life.