Medical Misdiagnoses Nursing Research Paper (Research Paper Sample)

Misdiagnosis in Health Care
Student’s name
Institution
Misdiagnosis in Health Care
* Factors leading to Misdiagnosis and its Impact
The effect of medical errors increases very day, ever since the first arrived value in 1999, which were 98,000 deaths due to medical errors. To make the situation even worse, Allen (2013) expresses his assertions that the count of deaths could be even higher, as indicated by the Office of Inspector General for Health and Human services, leading to almost a third of the total deaths in America. Diagnostic errors, especially misdiagnosis, are the most common form of medical and surgical errors, as the leading cause of adverse events in most medical operations. However, Ely, Kaldjian, and D'Alessandro (2012) encourage that they can be easily avoided through preventive measures.
Patient preferences have resulted to misdiagnoses, a sentiment expressed by Mulley, Trimble, and Elwyn (2012). It is, therefore, critical that patient preferences are considered to ensure that correct diagnoses are made as it is the only path to correct treatment. The technological advancements have led to increased number of patients who are handled per day, but with an increased risk of misdiagnoses as Singh et al. (2013) explain.
Ely, Kaldjian, and D'Alessandro (2012) establish that common factors that lead to misdiagnosis are failed heuristics (avoiding medical diagnosis procedures) and biases. This leads to a premature deduction, which is not evidence based practice. These malpractices might be hard to tell as at times; time pressure may force practitioners to make premature conclusions, in an attempt to serve more patients.
As there is a global concern about the quality of health especially improving on time management, rush decisions are made by doctors without adequate evidence to ascertain the presence of a given ill-health condition. This situation has been prevalent within the ambulatory paramedical services such as first aid. Saving time even within hospitals has led to increased inefficiency even within the hospitals. Missed diagnoses in primary care are later noted after a different practitioner re-examines the patient or unclear symptoms. Evolution of the initial symptoms to something clear or development of new symptoms has led to the discovery of misdiagnosis, which at times, appears a little too late.
As recent development in medical practices is geared towards quality, there has been an increased demand for emphasizing on quality in diagnosis. A thorough diagnosis will entail, physical examination, a revisit in the medical history of the patient, ordering tests and imploring the patients on their personal preferences and though on their ill health. Patients have developed a cautious attitude towards their treatment, and most of them will enquire more about their conditions. In the recent past, patients have been going online to find more information about their illnesses.
* PICO Table
P (problem)

Misdiagnosis in disease identification

I (intervention)

Proper insight to a patient and the indicators

C (comparison)

Assumptions and bias

O (outcome)

Reduced harm caused by improper treatment, improved quality of health care

How can we eliminate misdiagnosis in the health facilities and mitigate any harm that may be caused to the patients?
* Research strategy
Important aspects were searched using the key words; diagnostic errors, misdiagnosis, illness identification mistakes and adverse events in medical practices. Medical journals were assessed as well as nursing reports and health statistics from the respective departments. Seven articles were considered for this study. Most of them were research articles, with a described research methodology and analysis. Other sources that had been considered were commentaries from health care professionals and statistical reports analysis. Among the obtained evidence regards incidences of misdiagnosis that had been committed and were later recovered. For every single incidence, preventive measures were identified so that the harm caused by misdiagnosis can be minimized.
One of the research based evidence prompted the use of checklists to improve making correct diagnostic decisions. The study by Sibbald, de Bruin and van Merrienboer (2013) indicate that checklists can be used to verify the presence of a health condition. This will improve the correctness of the diagnosis, as it will be grounded on some evidence. The three authors noted that even though the method reduces the chances of errors, they can complicate the diagnosis process especially when used at every step of diagnosis. The study, used fifteen health experts who were used to interpret diagnosis without using a checklist as the control of using a checklist. The research used the experimental method to confirm or disapprove the value checklists.
The research evidence that the paper focused on is review of medical records. The major challenge of finding adequate source was that misdiagnosis is only identified after it has occurred. Second, most medical practitioners are paranoid of admitting their own mistakes as it may portray their incompetence and at times, lead to a lawsuit. A common way of detecting the errors was through a subsequent diagnosis of the patients, which when there was misdiagnosis, the following diagnosis would lead to negative results of the disease. Record based triggers, were used by Singh et al. (2013) as the main directives (indicators of possible misdiagnosis). The triggers would consider unexpected returns from patients ass it would signify ineffective treatment of the patient likely from misdiagnosis.
The second, nonresearch evidence sources, that were focused on were commentaries from renowned health practitioners. Allen (2013) acknowledges that losses that are incurred by all stake holders, the patients, the hospital and its professionals and the caretakers due to avoidable errors. The worrying statistical quotations that he puts in his article prompts immediate efforts to curtail the adverse effects. Croskerry (2013) proposes a more personal approach to reducing these errors by lobbying for a behavior change among the medical practitioners. He emphasizes on cognitive errors being the main cause of misdiagnosis which are mainly geared by clinicians’ way of thinking.
* Evidence Matrix
Authors

Journal Name/ WGU Library

Year of Publication

Research Design

Sample Size

Outcome Variables Measured

Level (I–III)

Quality (A, B, C)

Results/Author’s Suggested Conclusions

Ely, Kaldjian & D'Alessandro

The Periodical of the American Board of Family Medicine, 25(1)

2012

Used questionnaire that was administered to general health practitioners

202 samples were returned

Describing diagnostic error using a 1 page explanation

II

B

Diagnostic errors begin with a poor diagnosis, or misleading symptoms. Medical practitioners have to be alert of such mistakes by broadening their diagnostic exceptions and limiting their deductions to results that are evidence based

Singh, H., Giardina, T. D., Meyer, A., Forjuoh, S. N., Reis, M. D., & Thomas, E. J.

JAMA internal medicine, 173(6)

2013

Review of medical records-using the EHRs.

190 cases were reviewed

Data on missed diagnosis and other medical errors, and the potential harm that these errors could have caused on patients

III

A

Common diseases, that should be the least to identify still suffered from diagnostic errors. Some of the errors posed potential harm to the patients. Intervention ought to be developed especially when developing the patient-practitioner encounter errors, such as misdiagnosis

De Lusignan, S., Sadek, N., Mulnier, A., Russell‐Jones, D., & Khunti

DiabeticMedicine, 29(2)

2012

Search for people with diabetes and potential classification errors

347 records were identified

Pateints with typ1 yet diagnosed with type 2; patients with type 2, yet diagnosed with type1 and those without diabetes at all yet diagnosed with it

III

A

Often medical errors can be mitigated if the general practitioners can recheck diagnosis results by taking simple tests. This practice is bound to reduce misdiagnosis errors and the harm that may accompany it.

Croskerry

N Engl J Med, 368(26)

2013

Case study

2

Causes of errors and unprofessional perceptions were looked out

III

C

The case studies exemplify the situations that lead to bias and other factors that lead to misdiagnosis. The cases indicate the professional errors that are committed by medical professionals and challenges the professionals to embark on changing their attitude and general perspectives towards medical examinations.

Sibbald, de Bruin & van Merrienboer, 2013)

Medical Education, 47(3)

2013

Experimental method

15

The value of using checklists in improving medical diagnosis

III

A

The use of checklists among experts have been approved as an ideal errors reduction strategy, especially in diagnosis. However, it poses several challenges that are involved with its use, such as complexity and time consuming. All in all, a strategic use of checklists, will improve accuracy with minimized opportunity cost.

* Recommendations on Effective Strategies to Adopt
While fundamental errors lead to consequential treatment of a disease that is not there, the need to improve the primary diagnosis ac...