- Genuine care, concern and communication is important if a patient has a missed or delayed diagnosis, particularly if they suffer an adverse outcome.
- If an error is identified follow the open disclosure process and keep the patient well informed.
- Reflect on your practice and consider what modifications you can make to minimise the chances of an error happening again.
Frequency of diagnostic errors
Avant claims data indicates that 1 in 5 claims were primarily
about diagnosis. 75% of those claims related to missed or
delayed diagnosis. These events may not necessarily be as the
result of an error you have made; however, the ongoing patient
care and management may become your responsibility.
Managing the situation
- Personally, tell the patient – Depending on the urgency
of the diagnosis, contact the patient to inform them of
the unexpected finding and its implications as soon as
possible. A personal telephone call to set up a face-to-face
conversation generally works better, rather than delegation
to another member of the practice.
- Obtain advice – If necessary, before you meet with the
patient contact a specialist for advice on the likely treatment
required and the impact of the delayed diagnosis so you are
prepared to answer the patient’s questions when you meet
- Explain the situation – Have a face-to-face discussion
with your patient about the new findings. When doing this
follow an open disclosure process and acknowledge what
has occurred. You can express regret and say how sorry you
are about the unexpected news. The apology is not about
blame or liability, but rather about expressing empathy with
the patient for the events that occurred. Refer to Avant's Open Disclosure factsheet for more information.
- Arrange ongoing management of the patient and
immediate treatment – You should then explain what
treatment may be necessary. This may include a referral
for additional tests and specialist treatment. We would
recommend that you arrange this for the patient rather than
giving the patient a standard referral letter and asking them to
arrange their own follow-up consultation.
- Maintain contact with the patient – Remember to enquire
periodically about the patient’s progress and help them cope
with the feelings about the diagnosis or any possible delays.
- Consider the cause of the delayed diagnosis – After an
experience of a missed or delayed diagnosis, it might be
tempting to respond by over investigating every patient.
Critically review the decisions you made and consider
what your objective criteria for the management of similar
presentations in future patients.
- Review practice systems – If the delay was caused or
contributed to by a systems error, such as follow-up failure or
misfiling of pathology or diagnostic imaging reports, review
your systems to prevent a recurrence. Avant has a follow-up and recall factsheet with further information.
- Change and inform –The patient may appreciate hearing
about any steps that have been taken to avoid a repeat of the
- Notify Avant about the incident – As soon as possible
after you become aware of the incident, let Avant know. If
you receive a letter of complaint from the patient or their
representative, obtain advice from Avant before you respond.
- Consider cancelling or refunding your fee – Remember
to check your routine processes to make sure you don’t
inadvertently inflame the situation by sending an account or
fee reminder. It is better to forego a fee than risk offending the
patient. Not charging is not an admission of liability.
What if another doctor is responsible for the
misdiagnosis and you are now managing the case?
Diagnostic errors are not necessarily avoidable or as the
direct result of an error. The situation can become clearer
with hindsight. If you meet a patient who has been previously
misdiagnosed the situation needs to be managed carefully. When
discussing the diagnosis and its implications, stick to the facts.
You only have one side of the history and as such, it is better to
avoid any implied or stated criticism about the doctor(s) who may
have been involved with the previous error. It is not uncommon
for a legal claim or complaint to be pursued by a patient after
throwaway comments by the second doctor, which were not
intended to be a criticism.
Remain professional and objective during these exchanges.
If, at a later date, the patient’s solicitor seeks a report in the
investigation of a compensation claim, keep the report objective
and avoid criticism. You do not need to offer a medicolegal
opinion about the care provided by another doctor. Contact
Avant if you are unsure what is required.
As a guide, do what you would expect the other doctor to do
if the roles were reversed. This might include informing the
other doctor of the correct diagnosis and, if the patient agrees,
offering to send the patient back to that doctor so they have an
opportunity to explain.
How to reduce diagnostic errors
Reflecting on the events that may have contributed to a diagnostic
error or delay can assist in reducing future similar situations. Dr
Mark Graber from the Society to Improve Diagnosis in Medicine
suggests techniques to improve your clinical reasoning to reduce
the chances of an error being made. This includes an awareness of
when you ‘jump to conclusions’ and ultimately not relying on your
intuition. In addition, being comprehensive in your assessment by
considering what else the symptoms might indicate.
Practical tips to reduce some errors may include:
- seeking a second opinion
- developing a list of differential diagnosis
- ensuring follow up of all results
- being wary of overconfidence
- take a diagnostic time out – pause to reflect
- utilising checklists and mnemonics so you are less likely to
In addition, thoroughly documenting the diagnostic discussions,
investigative findings and follow-up actions you have taken in
your patient records could be key to demonstrating you have met
the expected standard of care, if an error was to occur. For further
information watch Avant’s interview with Mark Graber.
For more information or immediate medico-legal advice, call us
on 1800 128 268, 24/7 in emergencies.