Preventing Misdiagnosis and Other Diagnostic Errors: MSK’s Radiology Chief on What Can Be Done

By Christina Pernambuco-Holsten,

Thursday, November 5, 2015

A row of radiology scans hanging from the wall.

A recent report from the National Academy of Medicine singles out diagnostic errors as an all-too-common occurrence in healthcare — one with often-devastating consequences. Hedvig Hricak, MSK’s Chair of Radiology who was involved in the report’s publication, shares her views on the report’s findings, how patients can protect themselves, and why better communication is one of the keys to preventing errors.

  • Most people will experience one diagnostic error in their lifetime.
  • Poor communication among healthcare professionals is one of the greatest stumbling blocks.
  • You can protect yourself by asking questions — lots of them.
  • Expertise matters — not just your oncologist’s but your whole care team’s.

A woman visits her doctor with a health concern. A year later, after multiple tests and much stress, she finally has a diagnosis. Everyone has heard a story like this or even been through something like it personally. In the best of scenarios, the condition is not life threatening, but for far too many people, the consequences are serious.

According to a recent report released by the National Academy of Medicine, errors in diagnosis — defined as either inaccuracies or delays in making diagnostic information available — account for an estimated 10 percent of patient deaths, hundreds of thousands of adverse events in hospitals each year, and a significant proportion of paid medical malpractice claims. In fact, most people, the report states, will experience at least one diagnostic error in their lifetime.

Hedvig Hricak, Chair of Memorial Sloan Kettering’s Department of Radiology, served on the committee that published the report. We reached out to her to learn how people can protect themselves against errors, what the report means for the field of oncology, as well as next steps for the healthcare community.

In your view, what is the most significant finding in the report?

The report clearly demonstrates that the greatest stumbling block is poor communication among healthcare providers. That’s why our number-one recommendation is to facilitate more-effective teamwork among healthcare professionals, patients, and their families.

To be effective, the diagnostic process needs to be a dynamic, team-based activity whereby healthcare professionals communicate effectively not only among themselves but also with the patient and his or her caregivers.

This collaboration is more important in the field of oncology than ever before thanks to rapid advances in the field of precision medicine and, more specifically, in the molecular profiling of tumors. Precision medicine holds tremendous promise, but on a very practical level, learning how to integrate this new information with traditional pathology and imaging tests is going to require tremendous coordination and large investment — it’s actually given birth to a new field in bioinformatics called integrated diagnostics.

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What advice do you have for someone who’s recently been diagnosed with cancer?

It is disheartening to see the trouble that so many patients go through before the correct diagnosis is reached. That’s why it’s so important that people ask questions — about not only their oncologist’s expertise but also about the expertise of the whole team of experts caring for them. This includes the radiologists and pathologists.

Medicine today is all about teams, and it’s important that every single member of the team be excellent and knowledgeable. 

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Let’s talk about the expertise of MSK’s radiologists. What do they bring to the overall patient experience?

Our radiologists not only are trained in oncology imaging but also subspecialize in particular areas of the body. We have radiologists who subspecialize in gynecologic oncologic imaging, genitourinary oncologic imaging, and neuro-oncologic imaging, to offer just a few examples. This training gives our radiologists the ability to tailor their reports to individual patients and specific clinical scenarios, and we very much stand behind the value of this subspecialization.

Recently, we conducted two studies looking at the importance of subspecialty radiology training in patient management. The studies compared image interpretations submitted from other institutions to second-opinion interpretations issued by our subspecialists. In a study published in July involving men with prostate cancer, our radiologists’ reading of MRI exams changed the treatment plan in around 22 percent of cases.

Another study we presented last year showed a similar outcome for gynecologic cancer patients; the course of care changed in around 24 percent of cases after our radiologists read the MRI.  

This means that had these patients not come to MSK, many of them would have received care based on the initial interpretation of their MRIs, which was not the best plan for them.

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That seems like an astonishingly high percentage.

Yes, and that’s one area where I see a need for improvement — we need to do a better job educating patients and the healthcare community at large on the importance of cross-sectional imaging techniques such as CT scans and MRIs. Those studies are the essence of the diagnostic process for every cancer patient, and we need to communicate better about the significance of accurate interpretation.

Going back to the topic of communication, people often seem to have this perception of pathologists and radiologists as being very much behind the scenes.

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How do you nurture communication between these physicians and their patients?

First of all, pathologists and radiologists at MSK are very patient and family centric. I know that because I see all the time the thank-you notes and emails that come in from patients praising them for their contributions to their care.

Our patient portal has also helped to engage patients and their caregivers in the diagnostic process by allowing them to access their outpatient test results from home or on their phones. For radiology reports, for example, the radiologist’s name is listed on each one, so if the patient has questions, he or she can pick up the phone and call us directly.

Radiologists today have to be more than just “film readers.” It’s not enough for a report to be technically accurate; it also needs to be relevant and helpful to patients and the other professionals working alongside them.

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