Failure to diagnose and delay in diagnosis are some of the most common allegations of medical liability claims that we see at MagMutual. There are several known disease processes that are notoriously difficult to diagnose either because they mimic other, milder disease processes or their presentation leads the practitioner away from the correct diagnosis. Frequently this delay or misdiagnosis can lead to devastating consequences.
What is the patient safety and risk management point of view? What diseases do physicians struggle with diagnosing? Is there a common theme and why are they hard to pin down? Is there a means to diagnose these illnesses earlier?
- Pulmonary Embolus - PE is associated with in-hospital mortality and it frequently occurs in post-op situations and after hospital discharges. There may be legitimate debate as to the extent of VTE prophylaxis required in a specific case. However, when adverse outcomes arise, your defense will be bolstered by your documentation showing that you considered, in a reasonable fashion, the risks and benefits of the level of prophylaxis you chose. Aggressive attention to ambulation and drug intervention reduces PEs by 60 percent. So even if you are doing everything to prevent these diseases, they may occur. And it may be a masquerader, often misdiagnosed as a myocardial infarction or pneumonia.
- Necrotizing fasciitis - The “flesh-eating disease” is a rare infection of the skin and subcutaneous tissues, spreading along fascial planes. It progresses rapidly and has a greater risk of developing in the immunocompromised. It is of sudden onset and needs to be treated immediately with surgical debridement and intravenous antibiotics. At the outset it can look like a more routine cellulitis. Major clues can be pain out of proportion to history and exam, and abnormal vital signs (toxic appearance) in the setting of musculoskeletal pain.
- Vascular pathology in the neck - Compromise of cerebral perfusion secondary to disruption of blood flow in the neck can lead to devastating neurologic injury. There are a range of insults to the vasculature that can occur including clotting, embolism, trauma, and dissection. These manifest in various presentations. They can be silent, painful, or show vague neurologic symptoms. Investigation may require imaging that is not available in the necessary time at all institutions.
Discover seven more hard to diagnose diseases as well as related patient safety lessons by clicking below.