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69 Legal Consequences oftheMisdiagnosed Patient
527
defense contended that the cause of death was an arterial brain bleed unrelated to the fall. The jury found for ProHealth Physicians and Shastri. A defense verdict was entered, and no damages were awarded.
Failure to Diagnose William’s Disease. On December 17, 2012, Emilee Williams, 21, a graduate student, presented to Dr. Elene Pilapil at Mercy Clinic Springeld Communities with complaints of tremors, loss of balance, insomnia, difculty con­centrating, crying spells, and panic attacks. Dr. Pilapil diagnosed Williams with fatigue and depression with anxiety. He prescribed medication for anxiety and depression. On May 13, 2013, Williams returned to Pilapil with continuing com­plaints of resting tremors, difculty with handwriting, and general weakness. Dr. Pilapil again determined that anxiety with depression was the cause of her symp­toms and adjusted her medication.
Williams returned yet again on June 28 and reported she was having mental struggles, such as spells where she appeared inebriated and had a loss of balance, as well as fatigue and hand tremors. Dr. Pilapil, this time, ordered a magnetic reso­nance imaging (MRI) in August, which showed severe damage to the basal ganglia as a result of Wilson’s disease, a rare inherited disorder that causes too much copper to accumulate in your liver, brain, and other vital organs [24]. A urine test on August 12 showed low ceruloplasmin as a result of Williams’ excessive copper accumula­tion within her body. She sustained severe brain damage and impairments to her motor functions. Williams sued Dr. Pilapil and his employer Mercy Clinic Springeld Communities, alleging that the doctor failed to timely test her, failed to consider neurological diseases on a differential diagnosis, and failed to timely order a neurological consult and instead diagnosed anxiety without ordering testing to rule out the severe pathological cause of the patient’s condition. As a result of her disease, Williams suffered temporary quadriplegia, rendering her totally disabled and requiring 24-hour care. The defense expert neurologist testied that even if Pilapil had begun treating Wilson’s disease in December 2012, the outcome would have most likely been the same. The jury rendered a verdict for the plaintiff. The jury awarded total damages of $28,911,000 [25].
COVID Misdiagnosis
Any type of harm that results from the improper procedure may be considered neg­ligence. Here are some examples of how negligence can lead to harm:
By studying rapidly evolving literature and news for emerging diagnosis issues, Singh and Gandhi developed names for the types of diagnostic errors in an effort to help clinicians, other healthcare personnel, and the public:
• Classic: A delayed COVID-19 diagnosis due to a lack of accessible tests or tests
that read false-negative.
528
J. M. Ringer
• Anomalous: A COVID-19 patient is misdiagnosed as non-COVID when they
present uncharacteristic symptoms such as nausea and diarrhea, especially if
they lack respiratory symptoms.
• Anchor: Assuming someone has COVID-19 when they may have another illness
instead, such as bacterial pneumonia or sinusitis. Singh explains this can make
their conditions worse, especially if the patient requires antibiotics.
• Secondary: Because COVID-19 is a new virus, clinicians may miss underlying
or secondary conditions that it can cause, like blood clot-related lung complica-
tions. New inammation syndromes in children are just being described, for
example.
• Acute Collateral: Because some people fear venturing into hospitals or clinics
due to potential exposure, many remain home even when they have a stroke or
heart attack symptoms [26].
How Does aPatient Recover Damages inaLawsuit?
As seen from the above exemplars, evidence of malpractice from misdiagnoses is predominantly established through the presentation of expert testimony. Depending on the specialty and illness, doctors retained as testifying experts present evidence of the level of care appropriate in the circumstances based on the patient and their presenting condition, the skill, training, and experience of the treating defendant and any institution involved and then ultimately the actual treatment afforded by those medical providers. These testifying doctors are paid by the respective parties based on a review of the medical records, patient examinations, and information from scientic studies or learned treatises.
Damages: Plaintiffs in cancer misdiagnosis cases must prove that they were actu­ally harmed or injured by the failure to timely diagnose their cancer. In other words, the plaintiff needs to show that the misdiagnosis made their cancer less treatable or somehow changed their outlook to get compensation. This is often a contested issue of missed malignancy claims. Defense lawyers in cancer misdiagnosis lawsuits often argue that the plaintiff would have died even if the diagnosis had been timely made [27]. Patients in misdiagnosis cases claim to have been forced to undergo either unnecessary procedures or, in late-diagnosed cases, more invasive and drastic surgeries and treatments to try to address their illnesses.
Patients and their families may be able to recover some of the costs related to their misdiagnosis by ling a lawsuit. Some of the types of costs that can be awarded as part of a malpractice verdict include:
Economic damages like medical bills, lost income, cancer treatment costs, trans­portation to and from medical centers, and future expenses or losses resulting from your illness.
Noneconomic damages such as pain and suffering, disgurement, disability, loss of consortium/companionship, and other costs that do not have a strict mone­tary value.
69 Legal Consequences oftheMisdiagnosed Patient
529
The exact types of damages you can receive vary from state to state [28].
Moreover, many states have enacted laws that cap the maximum amount of cer­tain types of damages that plaintiffs can get in malpractice cases.

References

1. Maryland Misdiagnosis Lawyer | Medical Malpractice Misdiagnosis. https://www.millerand-
zois.com/maryland- misdiagnosis- lawyer.html
2. New Jersey Medical Malpractice Lawyer- The Reinartz Law Firm. https://reinartzlaw.com/
new- jersey- medical- malpractice- lawyer/
3. Singh H, Meyer AND, Thomas EJ.The frequency of diagnostic errors in outpatient care: esti­mations from three large observational studies involving US adult populations. BMJ Quality & Safety. 2014;23:727–31.
4. Misdiagnosis and Failure to Diagnose | Justia. https://www.justia.com/
injury/medical- malpractice/common- types- of- medical- malpractice/ misdiagnosis- and- failure- to- diagnose/
5. Dallas Failure to Diagnose Lawyer | Failure to Diagnose Cancer- Aldous. https://www.aldou-
slaw.com/medical- malpractice/failure- to- diagnose/
6. An Introduction to Medical Malpractice in the United States. https://journals.lww.com/
clinorthop/Fulltext/2009/02000/An_Introduction_to_Medical_Malpractice_in_the.4.aspx
7. Medical Malpractice and The New Jury Instructions. https://fagellaw.com/articles/
medical- malpractice- and- the- new- jury- instructions/
8. Misdiagnosis | Standards of Care. https://www.standardsofcare.org/medical- malpractice/
types/misdiagnosis/
9. Missed Diagnosis vs. Misdiagnosis | Cherundolo Law Firm. https://www.cherundololawrm.
com/blog/2022/october/missed- diagnosis- vs- misdiagnosis/
10. Torrey T.How common is misdiagnosis or missed diagnosis?, Verywell Health. 2011. https://
www.verywellhealth.com/how- common- is- misdiagnosis- or- missed- diagnosis- 2615481
11. How lyme disease is diagnosed. Verywell Health, 2012. https://www.verywellhealth.com/
how- is- lyme- disease- diagnosed- 2615338
12. United States: Toshiba medical ships 1,200th area detector CT system globally. MENA Report, Albawaba (London) Ltd, 2016. p. n/a.
13. Torres-Macho J., et al. Clinical features of patients inappropriately undiagnosed of pul­monary embolism. Am J Emergency Med. 2013;12:1646–50. https://doi.org/10.1016/j.
ajem.2013.08.037
14. $12.25 Million Jury Verdict in Misdiagnosis and Negligent Examination … https://www.
robertkreisman.com/medical- malpractice- lawyer/12- 25- million- jury- verdict- in- misdiagnosis­and- negligent- examination- of- prostate- cancer- screening/
15. Breast Cancer Misdiagnosis Lawsuits | Maryland Medical Malpractice Attorney. https://www.
millerandzois.com/breast- cancer- misdiagnosis- lawyer.html
16. Oncologist Malpractice | Baltimore Malpractice Attorney. https://www.millerandzois.com/
oncologist- malpractice- claims.html
17. Patient alleged that radiologist misread breast imaging- VerdictSearch. https://verdictsearch.
com/verdict/patient- alleged- that- radiologist- misread- breast- imaging/
18. United States: states strategize to increase trafc safety. MENA Report, Albawaba (London); 2017, p. n/a.
19. Rome Memorial Hospital Wins AHA Award for Life-Saving Heart Care. Bus J Central NewYork. 2020;34(34):7.
20. Mental Health Malpractice Cases | AZ Medical Malpractice Lawyers. https://www.vanosteen.
com/medical- malpractice/mental- health.asp
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21. Koneshloo A, Dongping D.Coronary heart disease diagnosis using kernel PCA and adaptive boosting. IIE Annual Conference. Proceedings, Institute of Industrial and Systems Engineers (IISE), 2018. p.1157.
22. ER physician failed to diagnose patient's stroke: plaintiff- VerdictSearch. https://verdictsearch.
com/verdict/er- physician- failed- diagnose- patients- stroke- plaintiff/
23. Patient claimed doctor failed to consider stroke in diagnosis … https://verdictsearch.com/
verdict/patient- claimed- doctor- failed- to- consider- stroke- in- diagnosis/
24. Medical Doctor on Instagram: “Wilson’s disease is a rare inherited … https://www.instagram.
com/p/BEyCHwyoaWh/
25. Vosburg v. Putney- Berkman Klein Center. https://cyber.harvard.edu/torts01/syllabus/read-
ings/sd1- vosburgvputney.html
26. Types of misdiagnosis that can harm patients during COVID-19. https://www.bcm.edu/news/
types- of- misdiagnosis- that- can- harm- patients- during- covid- 19
27. Maryland Cancer Misdiagnosis Lawyer | Settlement Compensation. https://www.millerand-
zois.com/cancer- misdiagnosis- lawyer- verdicts.html
28. Cancer Misdiagnosis Lawsuit | Failure to Diagnose | Talk to a Lawyer. https://www.consumer-
safety.org/personal- injury- lawsuits/failure- to- diagnose- cancer/
J. M. Ringer
Part XVI
An Editor’s Perspective
Chapter 70
Strategies toAvoid aMisdiagnosis
HassaanTohid

Introduction

The Misdiagnosis Casebook in Clinical Medicine, 1st Edition, is a thoughtful and well-represented educational resource. The determined and dedicated authors were guided by the editors, who spent months ensuring high-quality material intended to provide value to the reader. The casebook contains evidence-based knowledge to help clinicians avoid common diagnostic mistakes and aspires to serve as a guide to avoid a misdiagnosis pitfall. This writing project began in mid-2021 and culminated in late 2022. Thanks to the writing team and the publisher Springer Nature for mak­ing this book a reality.
The casebook contains 70 chapters, all of which contain common and unique clinical cases misdiagnosed by clinicians. This book will serve physicians, clini­cians, academicians, medical students, nurses, and other healthcare providers who face the daily challenges of diagnosing clinical conditions with unique presenta­tions. The ultimate goal of which is to benet the patient.
A common human characteristic is to make mistakes; no one can claim that he/ she does not make mistakes. However, the sign of a great learner is that he/she accepts the mistake and works toward improving the mistakes. This casebook will convey that all of us are human and make mistakes. Moreover, this casebook will serve as a helping tool to avoid many mistakes seen in clinical settings on an every­day basis.
The book’s title and concept show that misdiagnosis during clinical care is pos­sible and is not strange. Every clinician has misdiagnosed a disease at some point in his or her career, whether during student life, internship years, or post-internship
H. Tohid (*) California Institute of Behavioral Neurosciences and Psychology, Faireld, CA, USA
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 H. Tohid et al. (eds.), The Misdiagnosis Casebook in Clinical Medicine,
https://doi.org/10.1007/978-3-031-28296-6_70
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H. Tohid
clinical career. Since we all are prone to making mistakes, how do we rectify our mistakes? Should we deny the mistake and refuse to accept what has happened? Should we shift the blame to a fellow clinician? Or do we accept our mistake and take absolute responsibility for the error? Should we deny it and hide the mistake from others? Or work toward the improvement of our mistakes? If we deny and do not accept, what we are doing is not the right thing to do and can lead to patient harm. This book will help clinicians around the globe in minimizing the errors that they would otherwise make without this book. Our goal is to mitigate errors and raise awareness that medical misdiagnoses are expected and possible, with the ulti­mate goal of serving the patients.
This chapter intends to address strategies clinicians may adopt to reduce the number of errors that may lead to a misdiagnosis.
How toAvoid Misdiagnosis?
A study demonstrated that approximately 21% of patients with unplanned hospital­izations within the rst 2 weeks of a primary care visit had misdiagnosis [1]. Moreover, misdiagnosis also causes a substantial nancial burden on our society. Therefore, avoiding misdiagnosis is essential in providing better healthcare to soci­ety. However, we must partially avoid misdiagnosis because human errors will last as long as there is life on this planet. However, we can mitigate the number of mis­diagnoses by adopting specic strategies.
1. Attention
We must admit that misdiagnosis errors can only partially be avoided. Even after this book, clinicians will keep making mistakes, and misdiagnosis will remain one of the critical issues; however, the strategies mentioned in this chapter may reduce the chances of mistakes in misdiagnosis. I will address some evidence-based strate­gies and ideas that could play an instrumental role in avoiding misdiagnosis.
The rst and foremost factor that may help clinicians avoid misdiagnosis is pay­ing attention. Healthcare professionals at all levels must be cognizant of what is happening around them. They must be vigilant, carefully observe everything, and pay for all the signs and cues the patient provides during the clinical history. They must also pay attention while reading laboratory tests. Many problems related to a misdiagnosis can be resolved if the clinicians focus, concentrate, and pay attention to the patient, history, and ndings. Nowadays, distractions such as smartphones can lead to severe errors. For example, when we were supposed to listen carefully to the patient, we became distracted. We are worried about sending or receiving a text message or how many “likes” we received on our social media posts. Who replied to us or liked our social media posts? This situation can easily cause misdi­agnosis. Therefore, switching every distraction off, including cell phones, when with the patient and paying hundred percent attention to the patient can avoid or
70 Strategies toAvoid aMisdiagnosis
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reduce many errors, including misdiagnosis. The golden rule should be to pay hun­dred percent attention to the patient when with the patient.
2. Take Time
Another factor that can reduce errors and misdiagnosis is being patient and not being in a hurry to diagnose. We should take proper time, make sure the complete information is gathered, and analyze carefully. We should also spend time on the ndings, such as clinical history and lab ndings, and spend time “thinking.” Ideally when we think, we should think on paper. Making fast and rash decisions can be wrong; patience is critical.
3. Consult with Others
No one knows everything. No one achieves anything alone. The idea of self-made successful people is a myth because we all need people. We all need other people’s help and support. Even the most successful entrepreneur in the world cannot achieve anything alone. He has to hire people and has a team, different departments, and a coach or consultant to talk to. The same goes for any profession, including medi­cine. Teamwork and the help of others are way more important in medicine than in any other eld because it is a matter of someone’s life and death. It is imperative to involve as many people as possible. The new residents should consult their fellows and senior physicians in the hospital. The senior physicians should involve as many clinicians as possible to decide on a perplexing and challenging case. An important rule is always to seek advice and consult with others when in doubt.
Never think of yourself as someone who knows everything. Be willing to learn from others, and accept that no one is perfect.
4. Learning
Learning is a lifelong process, and we must develop a habit of lifelong learning. Take courses and classes; attend seminars and webinars, including continuing medi­cal education (CME) hours; and keep improving and growing professionally. The number of misdiagnosed cases can be reduced signicantly if everyone develops a habit of lifelong learning. Hospitals can also play an essential role in improving the quality of care by providing educational opportunities for all clinicians. Educational programs are one of the best ways to improve clinicians’ knowledge.
5. Experience
A clinician’s experience is one of the most valuable resources in the healthcare sys­tem today. Learning cannot compensate for the experience. To gain more insight and knowledge, young clinicians must practice lifelong learning and spend as much time with experienced clinicians as possible. In addition, patience is the key; new clinicians will also gain experience with time. The objective is to learn as much as possible, be patient, and resolve to gain more and more experience. They will 1 day realize that they make fewer mistakes and their diagnostic abilities have improved. They must realize that nothing happens overnight, and there is no shortcut. We all must be humble enough to accept the fact that there is always someone with more knowledge and experience around us.
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H. Tohid
6. Communication
We clinicians should strive to work on improving their communication skills. Better communication can reduce the cases of misdiagnosis [2]. Communication, as com­monly believed, is not just speaking and conveying our message; it is just one com­ponent of communication. Communication consists of reading, writing, listening, and speaking. We all clinicians should strive to work on all four components of communication. We should highly focus on listening. We can easily misdiagnose any case if we can communicate our message to other clinicians and patients but cannot correctly listen. The same goes for reading and writing. There are plenty of courses and books that teach communication.
7. Audits
Clinical audits are another way that can help us reduce cases of misdiagnosis. Audits are standard in the United Kingdom, and young clinicians actively conduct clinical audits. I believe all the hospitals around the world should adopt the concept of clini­cal audits to improve the quality of care and minimize misdiagnosed cases [3].
8. Checklists
I learned the concept of writing daily goals and checklists, drastically changing my life. While working at a drug rehabilitation facility, I strictly adhered to writing daily checklists of tasks and followed them religiously. This not only improved the quality of my work but also improved my patients’ well-being. I relied on the checklist, from the assessment to the diagnosis, and even during the therapy sessions.
One thing I learned that helped me change my life was that we should never trust our memory. We are humans, and we can make mistakes. Just like an airplane pilot relies on a checklist while taking off, ying, and landing, we clinicians must also rely on checklists because, just like a pilot, we are also responsible for other peo­ple’s lives. One missed question or a missed step can misdiagnose a disease and be lethal for the patient. Therefore, all clinicians must rely on making and following a checklist to avoid mistakes [4].
9. Technology
No one can deny the fact that technology is the need of time. We need technology to improve all aspects of our lives now. It increases efciency and productivity. The hospitals in rural areas of some developing countries where technology is not preva­lent or present may face challenges in proper diagnosis and treatment. The govern­ments should support the healthcare industry in those countries to adopt modern technology. Countries such as the United States, where technology is prevalent, must ensure proper training of staff and clinicians to operate better, handle, and read the ndings by modern machines to reduce diagnostic errors [5]. Technology itself will only help if the clinicians and the staff working at a hospital are equipped with the knowledge and expertise to operate the machines and understand the ndings provided by advanced technology such as function magnetic resonance imaging (fMRI) and other similar testing methods.
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10. Kaizen Principle
The concept of Kaizen suggests “improvement.” No one is perfect, and we all need improvement. In fact, if we are not improving and continuously learning and evolv­ing, we are declining. Therefore, we must adopt the habit of continuous learning regardless of age and experience. Every year we see drastic advancements in research and technology; therefore, if we are not updating ourselves with current research in medicine and healthcare and are not aware of the recent advancements in technology, then we will be left behind, and we will struggle to diagnose cases which otherwise would have been easily diagnosed with the habit of continuous learning and being updated. The most experienced and knowledgeable clinicians develop the habit of reading new research and keep themselves updated. PubMed is a great source to read new and modern research that new clinicians can read to improve and enhance their knowledge. Moreover, they can explore certain scientic journals related to their specialty to be aware of recent research to improve their knowledge. All these resources are just one click away and can be accessed on com­puter or cellphones. In these times of smart phone technology, if we are not learning and improving, we have no one but ourselves to blame.

Conclusion

The challenges faced by clinicians from other elds in diagnosis will remain as long as we humans run the operations in healthcare. Mistakes are unavoidable, not just in medicine but in all elds. The main characteristic of a human is making mistakes. There are no guarantees that mistakes will never occur, but we can mitigate them by adopting specic strategies such as continuous learning, collaborative teamwork, and a belief in continuous improvement.

References

1. Singh H, Giardina TD, Forjuoh SN, etal. Electronic health record-based surveillance of diag-
nostic errors in primary care. BMJ Qual Saf. 2012;21:93–100.
2. Singh H, Arora HS, Vij MS, Rao R, Khan MM, Petersen LA. Communication outcomes
of critical imaging results in a computerized notication system. J Am Med Inform Assoc.
2007;14(4):459–66.
3. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and
feedback: effects on professional practice and healthcare outcomes. Cochrane Libr. 2012.
4. Ely JW, Graber MA.Checklists to prevent diagnostic errors: a pilot randomized controlled
trial. Diagnosi. 2015;2(3):163–9.
5. Abimanyi-Ochom J, Bohingamu Mudiyanselage S, Catchpool M, Firipis M, Wanni Arachchige
Dona S, Watts JJ.Strategies to reduce diagnostic errors: a systematic review. BMC Med Inform Decis Mak. 2019;19(1):174. https://doi.org/10.1186/s12911- 019- 0901- 1.