Why Has Evidence of Error-Filled Diagnostic Medicine Not Led Changes Within the Profession?

Abstract

Research continues to indicate that medical practice is beset with a high rate of error and significant variations in diagnoses among physicians. In "Accuracy of Diagnostic Procedures: Has it Improved Over the Past Five Decades?" Leonard Berlin argues that the medical community has been aware of the high rate of errors and clinical variations for about 50 years, a claim that he supports by discussing the groundbreaking research on diagnostic and radiologic errors conducted by L. Henry Garland in the 1950s [1]. Garland's 1959 article, the basis for Berlin's discussion, was the first to reveal the high percentage of physician inaccuracy in a variety of diagnostic procedures. Berlin argues that, though research over the past half century has confirmed Garland's conclusions, the medical profession has been unable (or unwilling) to make the changes necessary to decrease the rate of error or incidence of variation among diagnosticians [1]. In light of mounting evidence and technological advances, this record causes us to ask why the profession has not taken steps to improve diagnostic accuracy. Early ResearchGarland's research on the accuracy of radiologic and other diagnostic procedures revealed a "surprising degree of inaccuracy" including "a 34% error rate in the diagnosis of myocardial infarction," an "agreement rate of only 7% among five experienced pediatricians" in the diagnosis of malnutrition in children, and "a 28% error rate among clinical laboratories in measuring the erythrocyte count" [2]. Another of Garland's striking findings was a 30 percent disagreement rate among experienced radiologists in diagnosing pulmonary tuberculosis [2]. When Garland's studies were published in the 1940s and '50s, the high rates of error and disagreement within the profession came as a shock to physicians and were described by a personal friend of the author's as "morally disturbing" [2, 3]. Berlin does not offer detailed discussion of Garland's explanation for the rate of error and variability among clinicians, simply noting that he attributed much of the error in radiologic diagnosis to basic human variation and the "still unexplained human equation" [2].