Implications of a Cancer Misdiagnosis

Nancy Hayes, a 63-year-old woman in West Palm Beach, FL, had her ovarian cancer misdiagnosed by her general practitioner as indigestion in 1995. A year later, Hayes was told by another physician that she had stage 3 ovarian cancer. Under the care of Dr. Jason Kapnick, an assistant consulting professor at Duke University and a practicing oncologist in Florida, Hayes underwent chemotherapy and radiation and lived the 5 years that patients with terminal ovarian cancer are typically expected to survive. Dr. Kapnick said Hayes’s early misdiagnosis stole valuable time from treatments that might have saved her life.


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Cases of cancer misdiagnosis that wind up in court are costly to the medical system, the justice system, and the patient who becomes a plaintiff. Medical liability coverage alone runs past $55.6 billion annually, according to a Harvard University study, which accounts for 2.4% of all healthcare spending.4 And while there are some cases of criminal misdiagnosis of cancer—such as the Michigan doctor arrested for misdiagnosing patients with cancer in order to bilk Medicare for over $35 million5—most instances of cancer misdiagnosis occur despite the best intentions.

Related: Cancer Medicine and Liability in the 21st Century

What Can Be Done?

Oncologists often care for many patients at once, which results in time constraints that may play a role in certain instances of cancer misdiagnosis, said McNeely. Rather than scale back the number of patients they treat, physicians surveyed instead pointed to advances in technology, communication, and EMRs as ways to reduce instances of cancer misdiagnosis, said McNeely.

The continued push toward EMRs plays a major part in making medical records more readily available, but EMRs can also lack accuracy. Even in EMR form, omissions or oversights in a patient’s record by their primary physician can deprive an oncologist of critical patient data. Compounding this problem is the fact that the incomplete use of EMRs by a large swath of small general practitioners still doesn’t fit the federal definition of meaningful use for EMRs, and therefore these physicians have no incentive to implement them, said McNeely.6

“The result of missing information in patient records is that you lose potentially vital and lifesaving clues as to what type of cancer you think you are dealing with. It’s not just having EMRs, it’s making sure they are filled out correctly,” said McNeely. “Physicians did tell us in the survey that the biggest barrier they encounter to complete and accurate diagnosis is where there is fragmented and missing information across the patient history.”

Physicians surveyed favored “establishing a voluntary misdiagnosis reporting system” within their hospital network more than they favored EMRs (16.5% vs. 14%).1 Incentives for doctors to confidentially report and document instances of misdiagnosis could help other doctors avoid similar mistakes, said Dr. David Harrison, Medical Director at Best Doctors, Inc., in Boston, MA.

“One solution may be to incentivize hospitals to develop and implement confidential misdiagnosis reporting systems, thereby encouraging doctors to make the reporting of misdiagnosis a standard part of clinical practice, just as medication or vaccine adverse events are reported currently,” Dr. Harrison said.

Such an internal reporting system would protect the privacy of patients with cancer, protect the reputation of hospitals and oncologists from unnecessary litigation, and produce more complete patient records, said McNeely, who added that the new survey itself demonstrates the willingness of oncologists to be candid about misdiagnosis when done in the right setting.

“Misdiagnosis affects a patient’s prognosis. It affects a patient’s chances of getting better. We’ve just got to get physicians and clinicians talking about this as a first step,” said McNeely. ”There is a need for precision, but also a need for healthy information exchange.”


References

1. National Coalition on Health Care; Best Doctors, Inc. Exploring Diagnostic Accuracy in Cancer: A Nationwide Survey of 400 Leading Cancer Specialists. January 29, 2013. http://www.bestdoctors.com/~/media/PR%20and%20Public%20Affairs/MisdiagnosisSurvey_FINALiv.pdf. Last accessed September 26, 2013.

http://www.bestdoctors.com/~/media/PR%20and%20Public%20Affairs/MisdiagnosisSurvey_FINALiv.pdf. Last accessed September 26, 2013.

2. Singh H, Sethi S, Raber M, Peterson LA. Errors in Cancer Diagnosis: Current Understanding and Future Directions. J Clin Oncol. 2007; 25(31):5009-18

3. Robert M. Wachter. Why Diagnostic Errors Don’t Get Any Respect – And What Can Be Done About Them. Health Affairs. September 2010. http://content.healthaffairs.org/content/29/9/1605.full.pdf+html.

4. Mello MM, Chandra A, Gawande AA, Studdert DM. National Costs of the Medical Liability System. Health Affairs. September 2013 issue.  http://content.healthaffairs.org/content/29/9/1569.full.pdf+html . Last accessed September 26, 2013.

5. Teichert E. Mich. Cancer Doc Charged With $35M Medicare Fraud Scheme. Law360. August 7, 2013.   http://www.law360.com/articles/462975/mich-cancer-doc-charged-with-35m-medicare-fraud-scheme. Last accessed September 26, 2013.

6. HealthIT.Gov. Policy, Regulation and Strategy: Meaningful Use. http://www.healthit.gov/policy-researchers-implementers/meaningful-use. Last accessed September 27, 2013.