Recently, a National Academy of Sciences’ Institute of Medicine report identified a huge problem in health care: the failures of health care providers to quickly and accurately identify a patient’s diagnosis. The report estimated that most patients will experience at least one wrong or delayed diagnosis over their lifetime.
In many cases that delay can have no serious consequence, in others the consequence can be deadly. For example, a delay in identifying a cancer can tip the scales from being easily treatable to catastrophic.
Diagnostic errors make up the leading type of malpractice lawsuits and are almost twice as likely as other claims to have resulted in a patient's death.
The report, “Improving Diagnosis in Health Care,” is the latest in a series issued by the Institute of Medicine that has examined medicine’s failures in protecting patients. A report done fifteen years ago, “To Err is Human,” found that tens of thousands of patients are killed each year due to negligent health care.
Sadly, too little has been done to respond to these reports. The most recent report argues that in the case of improving diagnoses, improvements are difficult to make. The report stated that there is no good way to monitor diagnostic errors, or of how often they lead to serious consequences.
The report does make recommendations – urging better teamwork and communication between health providers. The report also urges that patients look out for themselves. The lead author writes, “patients are central to the solution.”
Yet, most patients do little to look out for their own interests. They rely on the judgment of their providers – the doctors, nurses and other health care professionals – to treat them. Patients, and the general public, are at best dimly aware of the dangers of inadequate or negligent care. A few of those harmed seek compensation in court, but the vast majority of those who suffer from poor quality care assume it is the result of bad luck, not bad care.
The Institute of Medicine has done tremendous work in highlighted the silent dangers resulting from poor quality health care. It is the government’s responsibility to respond. After all, it is the government which licenses health care professionals and which pays for most of the bills through public programs such as Medicare. Unfortunately, too little has been done.
In fact, in last year’s budget the governor proposed to eliminate one of the state’s programs to make it easier for the public to review the backgrounds of their doctors. That website, nydoctorprofile.com, was spared as a result of support in the legislature.
But instead of merely maintaining an inadequate status quo, state government should be aggressively boosting its efforts to protect patients. Here are four steps that the governor should include in his upcoming budget plan:
1. Improve the doctorprofile website. The state’s website (nydoctorprofile.com) allows the public to easily examine a doctor’s background. The website has not been improved since it first went online 15 years ago. The state should modernize the website and require that a notice be posted in all health facilities to notify patients of its existence.
2. Overhaul the state’s program for tracking medical mistakes. The state requires that hospitals report medical mistakes to the Health Department. But the program is viewed as a failure and does little to strengthen the state’s oversight of the quality of care delivered in hospitals. The state should beef up its mandatory reporting system and sanction those hospitals which fail to do so.
3. Strengthen the state’s program for sanctioning poor quality providers. Health care providers are licensed to practice by the state, but the state has been criticized as doing too little to actively monitor those working in New York.
4. Require periodic recertification of doctors to ensure that they are maintaining their medical skills.
Those steps would begin to move New York in the right direction – toward protecting patients.
Blair Horner is the Executive Director of the New York Public Interest Research Group.