Becker's Hospital Review

37 Executive Briefing Misdiagnoses and Diagnostic Imaging: 2 Hospital CEOs on Subspecialty Radiology's Role M ost Americans will experience a diagnostic error at least once in their lifetime, according to the Institute of Medicine's September report "Improving Diagnosis in Healthcare." While misdiagnoses can occur at any point in the diagnos- tic process, many misdiagnoses are tied to diagnostic imaging. The level of clinically significant or major error in radiology ranges from 2 to 20 percent, depending on the radiological investigation, according to a 2001 study in the Journal of Ra- diology. However, when hospitals and other provider organizations use subspecialty radiologists when the case calls for it, error rates can decline. Here, Bill Lawrence, president and CEO of McLaren Central Michigan in Mt. Pleasant (part of McLaren Health Care), and Allen Weiss, MD, a physician board certified in internal medicine, rheuma- tology and geriatrics who serves as president and CEO of NCH Healthcare System in Naples, Fla., discuss the problem of misdiagnosis in healthcare and how subspecialty radiologists play a large role in the solution. Question: The IOM recently released a report on improving diagnosis in healthcare. How big of an issue is misdiagnoses? Bill Lawrence: Specifically with diagnostic imaging, the issue can be very significant. Some of the data suggest there may be an excess of 20 percent error rate, and that is certainly problematic. Dr. Allan Weiss: It's an issue. The problem is that we never typically know it's a misdiagnosis. The patient may or may not suffer, and certainly the people involved are embarrassed and not anxious to share that, so we never really know what our quality is. There's an old Shakespearean saying that the cemetery is full of doctors' mistakes. It's not a pleasant quote. But we really haven't been as objective as we could be in the age of digital medicine and digital communication. Having something like radiology, where there's an image or series of images that can be reviewed separately and independently — the differences that you come out with are astounding. There was a study out of Massachusetts General Hospital, where they showed the same radiologist the same images six months apart. A significant amount of time, they would come back with a different diagnosis. Even when you have two radiologists reviewing the same image, the discrepancies are significant. Sponsored by: "There's an old Shakespearean saying that the cemetery is full of doctors' mistakes. It's not a pleasant quote. But we really heaven't been as objective as we could be in the age of digital medicine and digital communication." — Dr. Allen Weiss, President and CEO of NCH Healthcare Systems

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