Why Are Diagnoses Compared?
Comparing antemortem and postmortem conclusions is a key indicator of a healthcare facility's quality of care and the professional level of its physicians. A high percentage of matches indicates good staff performance and high qualifications. However, discrepancies are inevitable in a certain percentage of cases.
The main goal of this analysis is to ultimately clarify the etiology, pathogenesis, and morphogenesis of the disease, as well as to objectively evaluate the appropriateness of the treatment provided. The review takes place in the format of a clinical-pathological conference, where autopsy results are analyzed in detail by the pathologist together with the attending physician.
Accurate diagnosis can be hindered by the patient's severe condition, inadequate patient self-reporting, laboratory or radiological errors, and insufficient physician experience.
Causes of Diagnostic Errors
All factors leading to diagnostic discrepancies are divided into two main groups:
- Objective causes. These are related to circumstances completely independent of the physician. They include a short hospital stay, severity of the patient's condition (including unconsciousness) preventing necessary examinations, and objective diagnostic difficulty (e.g., in rare diseases or atypical presentations).
- Subjective causes. Directly related to medical personnel actions. These may include inadequate patient evaluation despite available resources, misinterpretation of data (laboratory, radiological) due to lack of knowledge, an erroneous conclusion by a consultant, or improper formulation of the clinical diagnosis itself.
Categories of Diagnostic Discrepancies
Discrepancies are classified into 3 categories depending on the nature, causes, and consequences of the error. The analysis must take into account discrepancies in the underlying disease, its complications, and the localization of the pathological process. When a discrepancy is recorded, the physician must state its cause.
- Category I. Caused exclusively by objective factors. Criteria include a short hospital stay (no more than 3 days) or a severe patient condition that makes a comprehensive evaluation impossible.
- Category II. Causes can be either objective or subjective. The main criterion is that the diagnostic error did not lead to a fatal outcome and did not influence thanatogenesis.
Example of an objective cause: Pancreatic head cancer was diagnosed clinically, but autopsy revealed ampullary cancer (symptoms in the terminal stage are identical, the error did not affect the outcome). Example of a subjective cause: An 82-year-old female patient hospitalized for 60 days had a mild gastric cancer diagnosed while a massive 3-day-old myocardial infarction was missed. The error resulted from negligence (perfunctory rounds, failure to order ECG and troponins). Failing to recognize one of the competing diseases is considered a discrepancy since each could have caused death.
- Category III. Characterized by a diagnostic error that resulted in incorrect medical management, leading to fatal consequences (patient death). This often borders on medical malpractice.
Example: A patient was unsuccessfully treated for interstitial pneumonia with atypical symptoms. A phthisiologist suspected tuberculosis, but the attending physician only partially followed recommendations (performed a single sputum test) and continued ineffective therapy. Three weeks later, the patient died of caseous tuberculosis pneumonia. The error occurred without objective causes, and with correct diagnosis, the outcome could have been favorable.