The Washington Post wrote an article Monday underscoring fact that is well-known to lawyers handling malpractice cases in Maryland: doctors struggle to accurately read tests that determine medical conditions. Unfortunately for patients, this can have serious long-term consequences.
Most of these errors do not lead to malpractice cases because they show false positives. Sometimes these are malpractice cases because the unnecessary test is the harm — we tried that very case in Baltimore County last year and our client received a $1.45 million verdict.
Below are a few examples that I think really highlight the consequences of this problem. Each of these following examples and studies highlights the need for us to find a path to help doctors to improve their ability to assess tests more accurately.
Misdiagnosis of a 66-year-old man’s condition
A Journal of American Medical Association (JAMA) article discusses a misreading that resulted in a 66-year-old man having permanent speech and memory issues. He initially visited the hospital to seek treatment for a serious skin infection. He also had a fever, low blood pressure, and a headache. Doctors had him undergo a brain scan as well. They found a tiny bulge in his cranial arteries, which in hindsight, may not have been relevant to his headache or infection. Doctors then ordered an angiogram in order to get images of his brain’s blood vessels. They inserted a plastic tube in the arteries, through which they inject the dye. There was no evidence of blood vessel issues. However, the man had multiple strokes as a result of the injection. He now struggles with speech and memory issues now because of this.
False-positive troponin test results
False-positive tests are more common than you would like to think. This issue can cause patients being subjected to unnecessary medical procedures. A BMJ article notes that the high-sensitive troponin test, which checks for a heart attack, has an 84 percent false positive rate. U.S. emergency rooms also administer this test to people who have a low probability of a heart attack. This increases the chance for a false positive even more. These false positives can result in having a patient undergo unnecessary stress tests with expensive co-pays and invasive angiograms. Besides possibly wasting their own money, patients might receive complications more harmful than the condition that leads them to visit the hospital in the first place.
False-positive mammogram results
False positives are also very common for mammograms, which can cause a misdiagnosis of breast cancer. A study published in the Health Psychology Review examined the relationship between false-positive results and follow-up tests. Researchers note that between 6 and 15% of mammograms yield abnormal results. Most of them are false positives. Researchers note that this means that “about one-half of US women” can expect a false-positive result if they are screened regularly for at least ten years. False positives can lead to anxiety and worry among women who receive them. Researchers note that this may motivate some women to become more health-conscious and regularly undergo check screening. However, they feel that these psychological reactions are “negative to experienced should be minimized through intervention.” They concluded there should be another study that clarifies the relationship between false-positive results and follow-up screenings. Their study shows how important it is to understand a false-positive result.
Unnecessary testing in patients
In a 2016 study published in the American Journal of Medicine, researchers examined the treatment that 177 patients received. Patients were admitted to the hospital for different reasons such as broken bones and intestinal pain. Researchers examined the necessity of medical tests that these patients underwent. They found that over 90 percent of patients underwent medical testing and procedures deemed unnecessary. They also discovered nearly one-third of all the tests were extra. This shows how doctors struggle to accurately read test results, which can result in flawed analysis.
Overestimating the benefits of medical tests
The fact that patients undergo unnecessary medical procedures suggests that doctors might be overestimating a procedure’s benefits to a patient. A study published in JAMA reports that a majority of the doctors in their study did, in fact, overestimate the benefits and harms of medical treatments. Researchers had the participants respond to ten questions that pertain to the harms and benefits. They were also asked on a one to ten scale of how confident they were in their answers; one being not confident at all and ten being very confident. They found 78.6% of physicians overestimated benefits, while 65.8% overestimated harms. In addition, 67.5% of respondents reported four, which indicates that many of them are not confident in choosing the right medical procedure for patients. The researchers concluded that physician beliefs might contribute to misconceptions that patients may have on the benefits of medical treatments. This could result in medical overuse.