Diagnosing the Emergency Room Misdiagnosis Problem

This is not a space to praise the virtues of malpractice insurance companies. But let’s give credit to Crico/RMF a malpractice insurance company which insures Harvard-affiliated hospitals. Crico/RMF, according to the Wall Street Journal, put on an emergency medicine leadership summit to identify the critical factors that cause missed or delayed diagnoses of patients in the emergency room.

How did they do this? They looked at settled malpractice lawsuits and tried to breakdown what went wrong. They found that doctor-nurse communication breakdowns often happen at a critical juncture in a patient’s treatment. From this, they put together a list of best practices that hospitals can use to prevent misdiagnosis.

One problem focused on at this ER summit was the concept that doctors have a hard time changing their initial diagnosis when facts are uncovered that should take the doctors in a different direction. Doctors are stubborn to change their diagnosis. But it is not just doctors. It is a cognitive bias we all have. (I’ve written before about how before lawyers use anchoring at trial.) But the key for doctors is identifying the bias so they can confront it before it leads to the wrong diagnosis.

There was also another foreboding problem discussed at this summit: hospitals and doctors have become more dependent on electronic communication. If not confronted, this is a problem that will get worse as technology moves forward. It is troubling because we always think of technology in medicine as part of the cure instead of part of the problem. But hopefully, this effort and others like it can make real changes happen.