HOW SUPPOSEDLY EVIDENCE-BASED MEDICINE CAN BE MISLEADING
A recent article in Emergency Medicine News recaps news releases from late 2022 which reported that emergency physicians were killing their patients. An article published by The New York Times claims up to 250,000 people die every year due to misdiagnosis and failure to identify serious medical conditions.
Similarly, CNN warned readers that 1 in 18 patients are misdiagnosed, meaning that 2.6 million people suffer preventable harm every year. These assumptions come from a report published by the U.S. government, “Diagnostic Errors in the Emergency Department: A Systematic Review,”.
Authors estimated that among 130 million emergency department visits, 7.4 million (5.7%) are misdiagnosed yearly. 2.6 million (2%) of these patients suffer a resulting adverse event, and roughly 370,000 (0.3%) suffer serious harm, defined as death or severe disability. They also stated that an average of 25,000 of these doctors may witness 50 misdiagnosis-associated deaths every year, equally a death every single week.
This review was found to be a deeply flawed analysis. In the CNN report, the authors stated that they reviewed almost 300 studies over 20 years. However, it less obviously specifies that the error and harm rates referred to overall come from three smaller studies conducted outside the United States.
This means that the claim that patients die every other day due to misdiagnoses is actually based on three small studies conducted in other countries. The Swiss study combined a 12.3% diagnostic discrepancy with the Canary Islands’ 4.2% misdiagnosis rate and calculated that emergency physicians in the United States make a misdiagnosis 5.7% of the time.
The 250,000 U.S. deaths were extrapolated from a third study where 503 patients seen in the high-acuity side of two Canadian emergency departments where one patient died. This multiplied by 130 million undifferentiated U.S. emergency department visits resulted in the claim that more than 250,000 people die due to misdiagnosis.
A report by AHRQ targets the physician, claiming that, “ED diagnostic errors were mostly cognitive errors linked to the process of bedside diagnosis,”, citing medical malpractice claims as evidence.
The authors assert that 89% of misdiagnosis involves “failures of clinical decision-making or judgment.”. The report goes on to say this is most often attributed to inadequate skills, knowledge, or reasoning.
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From Emergency Medicine News