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When Is Misdiagnosis a Form of Medical Malpractice

Failing to diagnose and treat medical conditions accurately gives rise to the majority of medical malpractice litigation in the United States. Nearly 20 percent of patients report that doctors have incorrectly diagnosed them at some point. Sometimes doctors misread lab results, failed to take a thorough family history, or prescribed treatment for the wrong illness. In such cases, patients might have a claim for medical negligence based on a misdiagnosis.

Understanding the Duty to Diagnose

When a patient seeks diagnostic medical care, doctors must follow acceptable medical procedures to identify, verify, and diagnose an injury or illness. This process typically involves reviewing patients’ medical history forms, conducting physical examinations, discussing symptoms, and ordering diagnostic tests accordingly. Some doctors might also obtain and review a patient’s previous medical records and lab results. When physicians neglect these general duties, it often results in an incorrect or missed diagnosis.

Medical professionals generally assume patients have the most common condition associated with their age-range and symptoms, like allergies, and prescribe treatment accordingly. This assumption can result in doctors missing less common medical conditions, such as COVID-19 or lung cancer. The rarer the disease, the more likely patients will obtain two or three incorrect diagnoses before discovering the truth.

Whether an injured claimant can bring a legal action based on an incorrect diagnosis depends on each case’s specific facts, including what the doctor knew or should have known about the patient and the condition. For example, a primary care doctor should order a biopsy if they find a breast tumor in a 40-year-old woman with a family history of cancer. Failing to do so before the condition worsens might result in a claim for medical negligence. On the other hand, a family physician might not be negligent for mistakenly attributing a nine-year-old’s headache to dehydration instead of brain cancer.

Top Reasons Doctors Misdiagnose Patients

Multiple factors could contribute to a wrong diagnosis. However, medical studies indicate that doctors commonly misdiagnosed conditions due to:

  • Failing to engage with patients – Doctors often rush through diagnostic visits to maximize the number of patients they can see each hour. Some medical practices even encourage doctors to stand by the door to discourage patients from discussing their medical concerns. Failing to ask the right questions and take time to examine patients often leads to physicians missing critical symptoms and, in turn, misdiagnosing patients.
  • Not obtaining a patient history – Sometimes, patients contribute to the misdiagnosis by failing to provide a thorough medical history. However, doctors must generally ask questions about a patient’s prior conditions, medications, and treatments during examinations. The more detailed the patient’s medical history, the more likely it will be that doctors correctly diagnose an illness or injury
  • Misreading test or lab results – Doctors do not always thoroughly review anomalies in test results. They may mistakenly attribute abnormal results to a patient’s lifestyle or simply fail to compare results with a patient’s reported symptoms.
  • Failing to follow up – If multiple conditions present with similar symptoms, doctors can catch a misdiagnosis when initial treatments fail. Busy medical professionals often neglect to check in with patients about their symptoms and reevaluate an initial diagnosis. Instead, they may simply prescribe a different treatment for the same mistakenly diagnosed condition.
  • Not referring patients to specialists – Family practice doctors often act as a hub for patients’ medical needs. They often perform wellness checks and, if they identify a possible condition, refer patients to specialists. If a doctor fails to send a patient to specialists and subspecialists when necessary, this negligence could form a medical malpractice case.

It may take a few visits (or a few doctors) to get the answers you seek. Not every incorrect diagnosis will support a claim for medical negligence, but some cases might. A local attorney may work with medical experts to review your medical records and determine whether or not you’re entitled to compensation for an incorrect or missed diagnosis.

Filing Medical Malpractice Cases Based on a Mistaken Diagnosis

Diagnostics is both an art and a science. Even the best doctors might not correctly diagnose a rare condition. Professional malpractice litigation often hinges on determining whether or not the misdiagnosis was reasonable, based on each case’s facts and circumstances. Judges typically ask if a doctor with similar experience in the same field would have also misdiagnosed the condition. Expert medical witnesses must often testify for claimants during complex malpractice cases.

To recover financial compensation based on a false or missed diagnosis, a claimant must traditionally prove:

  • They were a patient of the physician and sought a diagnosis.
  • The doctor failed to follow accepted medical procedures.
  • The doctor misdiagnosed the patient as a result of this carelessness.
  • The patient suffered preventable physical or financial harm resulting from the incorrect diagnosis.

Injured claimants may generally file medical negligence claims against any licensed healthcare provider, including registered nurses, nurse practitioners, physician’s assistants, chiropractors, and dentists. Courts may consider the patient’s choices in presenting to a nurse rather than a physician. Still, licensed healthcare providers who misdiagnose common conditions, such as mistaking a heart attack for the flu, or do not refer patients to a doctor might bear liability for a misdiagnosis.

Proving Doctors Deviated from Medically Accepted Diagnostic Standards

Claimants often wonder why one doctor correctly diagnosed a rare condition while another failed to do so. However, not all doctors provide the same level of care. Generally, injured patients may only recover damages for a misdiagnosis if the doctor failed to abide by certain minimum medical standards. Just because a doctor was not as thorough as possible does not necessarily mean they are liable for medical negligence. The acceptable standard of care generally differs depending on the unique facts of each missed diagnosis case.

Courts often look at practices outlined in medical textbooks, hospital policies, and those generally employed by doctors of the same experience level in that area of practice. For example, if four out of five doctors would have requested blood work based on a patient’s symptoms, and the patient’s doctor did not, this may support a medical malpractice claim. The reverse is also true. If four out of five doctors would not have caught the condition, the treating physician might avoid liability. Doctors must often review an injured patient’s medical records and testify about the acceptable standards of care in their profession.

Frequently Misdiagnosed Medical Conditions in the United States

Most medical malpractice cases arise when patients present with symptoms, are mistakenly diagnosed, and, as a result, suffer preventable harm. Rare disorders that mimic more common illnesses account for most incorrect diagnoses in the United States.

Physicians often misidentify or ignore early symptoms of these conditions:

These conditions generally present with symptoms mimicking more common ailments, such as food allergies, pregnancy, PMS, headaches, the common cold, back pain, arthritis, and general fatigue. It isn’t until initial treatments fail that doctors begin questioning the original diagnosis and treatment plan. Sometimes, it’s nearly impossible to distinguish certain conditions when they first present. It’s also unrealistic to test for rare disorders immediately, and insurance companies seldom pay for immediate advanced testing. Most medical malpractice cases arise when a doctor should have known based on continued symptoms and failed treatments that they misdiagnosed a patient.

Litigating Reverse Misdiagnosis Cases

Though it sounds like a Hollywood movie, doctors have incorrectly diagnosed patients with serious or terminal conditions they did not have. This type of misdiagnosis might result in patients undergoing unnecessary chemotherapy or surgical procedures. Once patients have a diagnosis, treating doctors seldom go back and question the initial test results. Claimants might recover compensation if they underwent unnecessary treatment that caused them physical illness and financial losses. Patients might also request payment for emotional suffering and mental anguish stemming from an incorrect diagnosis.

Misdiagnosing Prenatal Conditions and Wrongful Birth Cases

An often-controversial subcategory of misdiagnosis cases involves the failure to diagnose serious prenatal conditions in infants. Healthcare professionals and OBGYNs could miss signs of a genetic disorder on ultrasounds or fail to interpret test results accurately. Most states recognize a cause of action called wrongful birth, designed to help parents recover compensation for parenting children with severe disabilities.

These cases differ from traditional prenatal malpractice cases, such as a doctor injuring an infant during the birth process, in that birth mothers must certify they would have terminated the pregnancy had the child been correctly diagnosed. In most wrongful birth cases, the children have debilitating emotional and physical conditions that prevent them from functioning without aid. Parents might recover compensation for special schools, nursing care, medications, and specialized medical equipment for disabled children in wrongful birth cases.

Recovering Damages in Medical Negligence Cases

In wrongful diagnosis cases, doctors do not generally cause direct harm. Physicians may agree that they negligently diagnosed a patient but argue that a correct diagnosis would not have changed the patient’s prognosis. For example, a doctor might have failed to recognize a rare type of cancer for which no treatment exists. Most cases involving false or delayed diagnoses hinge on whether patients suffered damages attributable only to the malpractice.

To recover financial damages from a healthcare professional, patients must generally submit evidence showing that the doctor’s incorrect diagnosis caused them more significant harm than the underlying condition. A typical example includes missing early signs of breast cancer when the disease was treatable. This error might result in the cancer spreading, necessitating more invasive treatment or a terminal diagnosis.

Similarly, patients subjected to unnecessary procedures resulting in painful side effects might also recover compensation. Liability for misdiagnosis litigation commonly turns on whether the patient suffered unique and preventable damages resulting from the doctor’s error.

Determining the Value of a Misdiagnosis Claim

Expert medical witnesses, often doctors in the same field, must typically work with medical malpractice attorneys to prove a health care professional deviated from the accepted standard of care. Doctors usually charge thousands of dollars for out-of-court services and tens of thousands during jury trials.

Likewise, experts must commonly work with economists to distinguish and calculate the damages caused by the misdiagnosis from those naturally resulting from the actual illness. While malpractice lawyers typically work on a contingency fee basis, such as taking a portion of the client’s overall recovery, plaintiffs must consider the value of a misdiagnosis case before filing a medical malpractice claim.

The most valuable cases frequently involve mistaken diagnoses that led to the patient’s death, necessitated more aggressive treatments, or subjected claimants to prolonged and unnecessary pain and suffering.

In such cases, patients (or their estates) could recover compensation for:

  • Medications
  • Medical equipment
  • Additional doctors bills
  • Emergency room expenses
  • Lost wages
  • Pain and suffering
  • Household help, such as cleaning and cooking services
  • Home nursing services
  • Medical transportation
  • Lost enjoyment of life and previous activities
  • Loss of spousal companionship

Courts strive to award plaintiffs compensation by placing them in the position they would have been in but for the negligent diagnosis. However, some factors may decrease a successful litigant’s overall damages, including a patient’s failure to follow treatment protocols, volunteer relevant information during the diagnosis process, or seek a second opinion when a reasonable person would have done so. Insurance companies often consider all these factors and may offer claimants a financial settlement for viable negligent diagnosis claims.

Timetable for Filing a Medical Negligence Claim Based on a Delayed Diagnosis

Every state has different laws specifying the time frame during which injured patients must file a misdiagnosis claim. You should consult with a lawyer as soon as possible to avoid waiving your claims. Some laws give patients extra time to file a malpractice claim if they discovered their actual condition years after the incorrect diagnosis, known as the discovery rule.

Applying this rule often depends on determining when or whether or not a patient should have known something was wrong and sought a second opinion. A medical malpractice lawyer near you might help you revive and file a claim based on an incorrect or delayed diagnosis after the general statute of limitations expires.

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