Where is your level of confidence when you go to the emergency room that you will get the correct diagnosis? While a report from the Agency for Healthcare Research and Quality states between 10% and 40% of all diagnoses are wrong, a 1997 National Patient Safety Foundation’s patient study reported that two in five adults had been personally misdiagnosed. Should this matter to you? The 2005 Annals of Internal Medicine suggest that most diagnoses result from doctors jumping to conclusions too quickly. With the high cost of medical testing and personal, misdiagnoses can be costly in more ways that just patient frustration.
My Experience with Death and Misdiagnosis
One spring night, I woke with cramping stomach and alternating sweats and chills. Since I had suffered food poisoning before and had eaten clams that night, I assumed I had eaten a bad clam and was suffering the consequences. I decided, after some self-debate, to go to the hospital to get relief of the symptoms.
I was met by a young enthusiastic ER nurse, who asked the basic triage questions. Here was a 40 year old male with night sweats, abdominal cramping, heartburn, so she thought a heart attack and ordered and EKG. After giving me the test, the young ER doctor asked, “Have you ever had an EKG before?”
“No, never had a need to. Am I having a heart attack?” I replied.
“Well the test came out a little irregular but it probably doesn’t mean much. But since we don’t have a baseline to compare it to, we better take a few more tests.” Now, I was beginning to have doubts that my problem was due to the clam. “We’re going to take some precautionary steps and schedule you for a stress test when the cardiologist gets in at 7:00 am.”
My confidence at this point was more than a little shaken and I was ruminating as to why I didn’t take out the extra life insurance I was considering. As they shaved little patches of hair off my chest, I weakly asked, “Can I have something for the heartburn?” By this time I was really worried and wrote my last will and testament on the little napkin they had given me with the dose of antacid.
To my amazement the cardiologist only briefly looked at my chart. “How are you feeling Mr. Friedman,” he asked.
“A little nervous. I have a nasty headache but my stomach feels quite a bit better since they gave me the antacid.”
The cardiologist asked two questions “Did you have any pain in your chest or arms tonight?” and “Do you now?” To both I answered no. He then scribbled something on the chart and as he took the probes off my chest, I heard him mumble, “If you’re not dying before you get here they’ll kill you when you do.”
“Don’t worry Mr. Friedman,” he told me. “You’ll be just fine. The headache is from the nitro patches. The antacid seems to have done its job. I think you had a case of food poisoning.” (Bad clam.)
The Positive Power of Measurement
In his best seller, Blink, Malcolm Gladwell relates a similar problem but on the doctor’s side of the situation. Cook County is a public hospital that serves a high number of patients without medical insurance. Therefore it runs on a very tight budget, but an unusually high percentage of patients were assigned to its coronary care unit that did not experience a heart attack. In fact, only 10% actually did have a heart attack. Understandable, no doctor want to take a chance of losing a patient to a bad diagnosis, but, the process led to unneeded and expensive tests, bed days, and doctor and nurse time both for the hospital and the patient.
Dr. Brendon Reilly ordered a study to determine accurate predictors of a heart attack. The results were staggering and an algorithm was designed to help doctors predict a potential heart attack with a high degree of certainty. While hesitant at first, the doctors discovered that this process focused on improving the rate of correct diagnoses was 70% more accurate than their predictions based on experience and skill. The algorithm process was accurate 95% of the time. Numbering such as this shows the positive side of performance measurement.
The Algorithm
The algorithm used at Cook County looks at three urgent risk factors. If all three factors are true, the likelihood of a heart attack is probable and the patient is admitted to the coronary care unit. If two of the three are true, the patient is assigned to a low risk care unit. If only one of the factors is true, the patient is assigned to a short stay unit for observation.
More Information is not always better
As I stated before, most misdiagnoses are due to doctors jumping to conclusions too soon. In my case, I did not have pain in my chest or arms. The only pain was due to abdominal cramping. I see businesses suffering from the same misdiagnoses and resulting in unnecessary expenditures. These diagnoses often lead to complex, intuitive and historical set of data to guide their businesses. Too many times, these truths create a tangled web of incredibly complex and confounding set of metrics that drives people to overly focus on process detail and specialization.
Key Organizational Performance Measures
There are probably three to five areas in your business that are critical to its success. Performance measurement in these areas will provide you a quick visual overview allowing you to improve, change, or remove certain tasks in order to increase the organization’s bottom line. Yes, you will need to be ready to quickly change your focus accordingly to compete and meet the sophisticated and constantly changing needs of your clients. However, by establishing good and accurate performance measurements you won’t be making a misdiagnosis that could be detrimental to your bottomline.
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