Our health care system is inefficient with physicians’ time. One study found doctors spend about 17% of their time on administrative tasks. A systematic review of 23 specialties found physicians spend from 9 to 19 hours a week on administration.
Overall, physicians spend 15.5 hours per week on paperwork and administration, according to the report. Of that, nine hours are on EHR documentation.
In recent years there has been a push to get doctors to use electronic medical records (EMRs). I’ve heard stories of physician appointments that involve patients describing their symptoms while their doctor has his or her face buried into a computer screen. Many EMR systems are not intuitive, requiring doctors to struggle with patient information entered on multiple page EMRs with pulldown menus.
EMRs presumably require your doctor to either spend more clinical time struggling with a computer rather than observing their patients or are preoccupied and only giving patients half of their attention. I wonder if cumbersome EMRs leads to missed diagnoses or failure to observe something that otherwise would have been caught. At the very least it certainly would not help.
A new study finds that diagnostic errors lead to 800,000 cases of death or permanent disability each year.
About 371,000 people die and 424,000 sustain permanent disabilities – such as brain damage, blindness, loss of limbs or organs or metastasized cancer – each year as a result.
Nearly 40% of those severe outcomes including death and permanent disability are linked to errors in diagnosing a group of five conditions: stroke, sepsis, pneumonia, venous thromboembolism (a blood clot in a vein) and lung cancer.
Then there is the problem that most doctors are now employed by hospitals, health plans, health care systems or group practices owned by private equity. Most physician visits are reimbursed by third parties or at least paid based on third-party reimbursement schedules. This does not lend itself to doctors being able to spend more time with one patient than another without reducing income.
Although those five conditions aren’t the most frequently misdiagnosed, they have the largest impact, and the study findings can help prioritize areas for investment and interventions, he said.
Spinal abscess, an infection of the central nervous system, is misdiagnosed more than 60% of the time, according to the report. But with 14,000 new cases each year overall, that leads to about 5,000 serious harms – a relatively small portion of the overall burden of diagnostic error.
But stroke, which the report found to be the top cause of serious harms, is a relatively common condition with a high risk of severe outcomes, and it’s misdiagnosed more often than average. About 950,000 people have a stroke each year in the US, and it’s missed in about 18% of cases, according to the report – leading to about 94,000 serious harms each year.
Diagnostic errors are generally the result of attributing vague, nonspecific symptoms to something that is common or at least more common than a serious condition. For instance, trouble speaking or moving an arm or trouble walking is easily identified at a stroke but simple dizziness or a headache is often mistaken for something else. The study noted that it looked at missed diagnosis within health care but a bigger problem is when patients assume vague symptoms are nothing to worry about and don’t even seek care.
Many doctors would probably disagree, but our health care system is not very patient centered. Patient interactions are often dictated by how patient visits are paid for. When physicians are compensated by the number of patients seen, and a substantial portion of revenue is consumed with overhead, it should come as no surprise that conditions with vague symptoms sometimes slip through the cracks.