Missed Diagnosis

A missed diagnosis by your healthcare provider is grounds for a medical malpractice case.

Is a Missed Diagnosis Considered Medical Malpractice?

Between 65,000-200,000 deaths occur each year because of medical errors. One cause of these errors is a missed diagnosis by the healthcare provider. In many instances, these missed diagnoses are grounds for a medical malpractice case.

If you believe you were injured because a doctor or other healthcare provider missed a diagnosis you need an attorney who specializes in medical malpractice. But, before you move forward with selecting an attorney, please read the following article from D’Amore Personal Injury Law. It will provide you with information to help you understand medical misdiagnosis and whether or not your case is one that rises to the level of medical malpractice.

What is the Duty to Diagnose?

Before determining if you have a malpractice case it is important to understand a healthcare professional's duty when it comes to making the correct diagnosis, i.e., the cause of your symptoms or problems with your health. The process for evaluation of a possible condition and determining a diagnosis is part of a provider’s medical education and training. Once the cause has been identified the provider can begin treatment for your condition.

The diagnostic process includes:

Collecting Medical History:: This includes your current medical conditions, medications, family history, allergies, habits such as alcohol and cigarette use, and any current symptoms – either associated with your reason for seeing the provider (chief complaint) or your other medical conditions (review of systems). If necessary, providers should review medical records from the previous clinic or hospital visits, as well as any procedures or treatments you may have received. These records should be requested if their review will assist in making the correct diagnosis.
Performing a Physical Examination:: This may be a general examination or focused on your current problem if you are seeing a specialist.
Ordering Diagnostic Tests and Understanding the Significance of the Results: What tests are to be ordered is based on the diagnostic standards for the problem seen. For example, a person with risk factors for a heart attack should have an ECG ordered and the results accurately read.
Obtaining Consultations From Specialists:: Occasionally, the patient’s presentation is beyond the expertise of the primary care provider. Under these circumstances, a consultation is indicated so that a specialist with more extensive training can evaluate the condition.
Maternal Shock in Pregnancy or Birth:: Maternal shock is a decreased blood pressure in the mother. It can occur from blood loss during birth or a severe type of infection known as sepsis. If unrecognized and untreated, the decreased maternal blood pressure can injure the mother and lead to inadequate oxygen delivery to the baby resulting in fetal asphyxia.

Why Do Medical Providers Miss Diagnoses?

Although not all complaints result in a definite diagnosis, many conditions are missed resulting in errors that cause significant injuries to patients. As we discussed above, there is a series of steps that must be properly followed so that conditions are properly diagnosed and treated.

Unfortunately, with financial pressures causing providers to see more patients in a given amount of time, activities such as a thorough history and physical examination are often skipped to save time. If a patient is uninsured, or because of certain health plans such as HMOs in which testing decreases a provider’s reimbursement, important diagnostic tests are skipped. These health plans may even financially penalize a primary care provider if they consult a specialist.

Lastly, as providers become busier, they spend less time following up with patients. This leads to missed opportunities to consider potential changes in the patient’s condition as part of the diagnostic picture.

Following are some examples of missed diagnoses:

Failing to Obtain a Complete Patient History:

Obtaining a complete history, including asking the proper questions, can provide clues to the cause of a patient’s problem. Not doing so may cause a provider to miss a diagnosis with disastrous consequences.

Example: A patient complaining of fatigue and weakness may also have symptoms of abdominal pain and black stools along with a family history of overactive bleeding. Knowing those facts would lead a reasonable provider to suspect the patient is anemic from gastrointestinal blood loss: a condition that can be fatal if not treated. Not knowing this important information can lead a provider to suspect the patient is simply not getting enough rest. See the difference?

Failing to Thoroughly Examine the Patient:

Performing a thorough examination is critical in making an accurate diagnosis. The body offers many signs that provide clues to a potentially dangerous condition.

Example: A patient involved in a motor vehicle accident should receive an examination of the spine, have an evaluation of their motor strength and sensory function, and have their reflexes checked to determine the presence of a spinal cord injury. If a provider skips any of these steps, the patient could be discharged with an injury that later manifests in paralysis.

Not Ordering the Proper Diagnostic Tests:

Sometimes a good history or examination may not reveal the cause of a condition. Some tests are strongly suggestive of a condition and if positive may indicate more definitive treatment.

Example: someone suspected of having a heart attack should have a blood test for the level of troponin in their system. A positive troponin test should lead to further work-up that would uncover critically clogged arteries. Not ordering the test may cause the heart attack to be misdiagnosed as indigestion, and the opportunity for timely treatment of the clogged arteries could be missed.

Not Consultations Specialists:

Many conditions may be beyond the knowledge base of a primary care provider. Specialists usually have a more focused understanding of symptom combinations than generalists. However, generalists need to know when a specialist is needed on the case.

Example: The cause of subtle and transient abdominal pain can be chalked up to a stomach virus by a primary care doctor. However, because of her specialized training and more focused experience, a gastroenterologist may see a pattern in the pain consistent with the presence of colon cancer. Unless the primary care provider is diligent enough to refer her patient to the specialist, the cancer could be missed long enough for it to become untreatable.

Maternal Shock in Pregnancy or Birth:

Many conditions do not present right away with all the clues to a condition. Symptoms and signs may change in their presentation over time. In other situations, a condition may have been thought to have been adequately treated but may have recurred. Because of these possibilities, it is essential that providers maintain vigilance in following up with their patients with repeat visits that may include questions about a change in interval history (“did anything change since I last saw you?”), physical examination, and follow diagnostic testing. A follow-up visit may also involve a review of any tests ordered on the patient to inform them of any indicated treatments.

Example: An oncologist fails to make proper follow up appointments after treating a patient for lung cancer. Therefore, the patient's new development of unintended weight loss is not known to the doctor. Knowing about these changes in a timely fashion would have caused repeat diagnostic tests to look for a recurrence of the cancer, which may have been treatable if caught early enough.

How do I win my Medical Malpractice Case?

First, you must be able to show the provider actually had a doctor-patient relationship with you.

This can be demonstrated by producing documentation regarding your visit(s) including:

The dates you saw the provider
The time and place of your visits
The name of the provider
The providers' notes

Next, you must be able to show the provider neglected to follow the proper diagnostic procedures for your particular complaints. This component is what lawyers call “the standard of care”.

Evidence of this may include the failure to take a proper history, failure to perform a physical examination, failure to order the proper tests, or failing to consult the proper specialist.

Finally, you must be able to show that you suffered an otherwise avoidable harm as a result of the provider’s poor care. Evidence of this may be that you had a curable disease that became terminal due to the delay in getting the right diagnosis.

I think I have a case of missed diagnosis; What should I do?

The first thing you must do is find a lawyer experienced in missed diagnosis medical malpractice cases. The attorney you choose should have a proven track record of success, the resources to see your case through, and the commitment to helping you get justice.

When you initially meet with the attorney, you will discuss the facts of your case and the effect the missed diagnosis has had on your life. The attorney may have a medical expert review the records to make a determination if there was a failure to properly diagnose your condition and whether that failure led to your injury. If there is enough evidence to proceed with a lawsuit, they will share with you the steps involved in a lawsuit, what needs to be proved in court to win your case, and the next steps to take in filing a suit.

Your case may not necessarily go to trial but may instead be settled. In either case, your lawyer should work diligently to obtain the compensation you deserve.

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