The PSNet Collection

Bias in mental health diagnosis gets in the way of treatment.

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Garb HN. Psyche. March 22, 2022.

A wide array of biases can affect clinical judgement and contribute to diagnostic error. This article discusses the impact of implicit biases, test inaccuracy, and data weaknesses in diagnosis of mental health conditions in both children and adults. The author provides recommendations for clinicians and researchers to reduce the impact of bias on diagnosis.

She was headed to a locked psych ward. Then an ER doctor made a startling discovery.

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Boodman SG. Washington Post. February 12, 2022.

Misdiagnosis over a long period of time can be acerbated by stigma and cognitive bias. This news story illustrates the problem of omissions due to potential stigma associated with patient mental health issues that contributed to a missed diagnosis. The author discusses how clinician experience led to flagging of a different testing approach to reveal a diagnosis that, once addressed, improved the patient's health.

Achieving Excellence in Cancer Diagnosis: Proceedings of a Workshop—in Brief.

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National Academies of Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press; 2022.

Diagnostic errors remain an ongoing challenge in many medical specialties, including oncology. This workshop reviewed the evidence base examining challenges in cancer diagnosis, discussed suggestions for improvement in the field, and looked toward a safer future for cancer patients.

Ripped apart: medical misdiagnosis and malpractice.

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Kast S, Gerr M, Black D, et al. “On the Record.” WYPR. August 3, 2021

Misdiagnosis is a persistent challenge for patients and families to navigate. This audio news segment highlights one family's experience with poor care stemming from disrespect and premature closure that resulted in missed diagnosis, unnecessary care, and patient death. The story is coupled with a broader discussion on the extent of diagnostic errors and reasons they occur.

Unwell Women: Misdiagnosis and Myth in a Man-Made World.

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Cleghorn E. New York, NY: Dutton; 2021. ISBN: 9780593182956.

Women have been affected by implicit bias that undermines the safety of their care and trust in the medical system. This book shares the history anchoring the mindsets driving ineffective care for women and a discussion of the author’s long-term lupus misdiagnosis.

Machine learning is booming in medicine. It’s also facing a credibility crisis.

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Ross C. Stat News. June 2, 2021.

Artificial intelligence and machine learning are often promoted as tools with impressive potential for generating rapid improvements in healthcare decision making. This news story highlights how underlying problems and testing failures limit the trustworthiness of conclusions drawn by the systems.

Cancer diagnoses delayed among prisoners in Washington state.

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Medscape Medical News. May 12, 2021.

Delays and mistakes in health care for distinct patient populations hold improvement lessons for the broader system. This news story highlights problems in correctional system cancer diagnoses and treatment that may indicate other types of prison care delivery problems.

Endometriosis affects 1 out of 10 women like me. Yet it often takes a decade to get diagnosed.

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Peikoff L. NBC News. March 31, 2021.

Patients with endometriosis often experience care delays and misdiagnoses that contribute to harm. This news story discusses a patient’s experience with common contributors to delay that include Insufficient clinical knowledge of the disease and a lack of uniform treatment guidance.

My life was upended for 35 years by a cancer diagnosis. A doctor just told me I was misdiagnosed.

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Henigson J. Washington Post. March 26, 2021.

Misdiagnoses can persist due to heuristics, discontinuities, and implicit bias. This news story chronicles the experience of a patient misdiagnosed with a brain tumor. His condition was eventually discovered through communication with a physician whose experience with similar situations allowed the physician to identify the problem.

A woman’s laborious search uncovered the probable cause of her searing abdominal pain. Getting a doctor to help was much harder.

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Boodman SG. Washington Post. February 20, 2021.

Difficult diagnostic journeys are compounded by lack of clinician empathy, bias awareness, and critical thinking. This piece shares the story of a patient whose efforts to identify the cause of her pain were hampered by heuristics, premature closure, and poor patient relationship building.

4 skin conditions doctors often misdiagnose.

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Oglethorpe A. Women's Health. November 4, 2020.

Skin condition diagnosis is a visual activity that is vulnerable to error. This article highlights how conditions such as psoriasis and skin cancer can be misdiagnosed. The piece shares recommendations for patients to obtain an accurate diagnosis such as seeking a second opinion and preparing for appointments with notes and questions.

Using Twitter to assess patient takes on patient experience.

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Heath S. Patient Engagement HIT. October 29, 2020.

Twitter is evolving as a useful data source for patient safety. This news story discusses an examination of public use of a patient-complaint hashtag that recorded patient experiences of misdiagnosis, disrespect and miscommunication that contributed to poor relations with physicians, medical errors, and harm.

Why false positives merit concern, too.

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Wu KJ. New York Times. October 25, 2020.

False-positive test results, while rare, can create conditions for patient harm. This news story discusses negative impacts of a false-positive COVID test. The unintended consequences of the mistake could be unneeded isolation, inappropriate treatment and patient exposure to infection due to isolation strategies in care facilities.

A doctor gave me an inept diagnosis for a neurological problem. I should know: I’m a neurologist.

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Horowitz SH. Washington Post. October 4, 2020.

The harm of misdiagnosis can be extended by lack of clinician recognition and acceptance of the error when a patient raises concerns. This news story shares the experience of a physician-patient whose recognition of a diagnostic mistake was initially dismissed. The author defines the repeated lack of organizational willingness to resolve the situation as a normalized deviance in health care.

The slow, troubling death of the autopsy.

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Ashworth S. Elemental. September 22, 2020.

The rate of autopsies – the “gold standard” of death investigation – are decreasing worldwide. This commentary highlights the lost opportunities for hospital and clinician learning from mistakes due this decline. The author ties the relevance of the loss to missed opportunities for understanding the effect of COVID-19 on the body to inform diagnostic, treatment and prevention activities.

Patient Safety

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Organisation for Economic Co-operation and Development.

Organizations worldwide are focusing efforts on reducing the conditions that contribute to medical error. This website provides a collection of reports and other resources that cover activities and concerns of the 37 member countries active in the organization to address universal challenges to patient safety.

Doctors turned my sister away; less than two years later she died of cervical cancer.

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Harvey-Jenner C. Cosmopolitan. August 27, 2020.

Implicit biases are known to impact effective diagnosis. This story highlights how dismissed concerns resulted in a delay in cancer diagnosis that contributed to the death of a young woman.

When the misdiagnosis is child abuse.

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Clifford S. The Atlantic. 2020;August 20.

Diagnostic decision-making is susceptible to cognitive biases and error in stressful situations. This feature article illustrates how misdiagnosed child abuse can not only affect the patient but create collateral damage to the families involved.

As college students return, a crisis in campus care awaits.

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Abelson J, Tran AB, Kornfield M, et al. The Seattle Times. 2020;July 13.

The COVID-19 pandemic has impacted health care delivery in a variety of settings. This magazine story shares the results of interviews with university students across the country to identify weaknesses found in college health center processes that have resulted in care delays and misdiagnosis.

First Do No Harm. The Report of the Independent Medicines and Medical Devices Safety Review.

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Implicit biases are known to affect the safety of health care. This analysis of the National Health Service (NHS) found weaknesses in NHS’ consideration of and response to women’s medication and medical device concerns. Among the recommendations submitted to improve patient centeredness and respect for patients are the establishment of central yet independent authority to serve as the conduit to address patient concerns and improve system safety accountability.

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