( 15 ) DIAGNOSTIC ERROR SURGICAL SERVICES IN THE OFFICE-BASED SETTING When general medicine clinicians refer patients with potential breast, prostate, or lung issues to the surgical services of a gynecologist, urologist, or pulmonologist, they, and their patients, presume the responsibility for the diagnostic process shifts to those surgical specialty providers. When those encounters fail to identify a subsequently diagnosed cancer or a post-operative complication, it is to these specialists who patients and their attorneys will direct the question, “How could you have missed this?” | HIDDEN IN PLAIN SIGHT | Exposing the Drivers of Diagnostic Error A DOSE OF INSIGHT ® Coverys | Top Clinical Services While only 23%, surgical services is the second highest contributor to allegations of diagnostic error occurred and accounted for 22% of the indemnity paid. Top Surgical Services Of all the office-based surgical events in this study, orthopedic is the service with the highest percentage of diagnosis-related events at 31%. These most frequently involved a pre-operative condition that was not addressed or a failure to identify an infection or other post-operative complication. Cancer was the most frequently missed diagnosis for urology, gynecology, and general surgery. General Medicine Medical Sub-Specialties Pediatrics EENT Surgical Services % Events % Indemnity Paid 41% 45% 23% 22% 18% 15% 6% 5% 7% 8% TOP CLINICAL SERVICES CASE SUMMARIES Failure to diagnose post-op infection following a partial knee replacement resulted in sepsis, kidney failure, and required a lengthy rehabilitation stay. The patient was placed on an antibiotic but did not receive appropriate instructions to report to the ED if symptoms worsened while waiting for a scheduled surgical revision. Failure to appreciate an incidental finding of a suspicious mass in the course of orthopedic care resulted in delayed diagnosis of ovarian cancer. The patient, in her 50’s, originally pre- sented with hip pain. Imaging revealed a mass suspicious for ovarian cancer. The orthopedist took action on her osteoarthri- tis and femoral acetabular impingement findings but did not address the mass or refer to gynecology as recommended. The patient was ultimately diagnosed with stage 3 ovarian cancer. Orthopedic GYN General Podiatry Urology % Events % Indemnity Paid 31% 33% 18% 33% 16% 9% 10% 10% 2% 9% TOP SURGICAL SERVICES N=552 events with a diagnosis-related case type in the office-based setting closed 2020-2024. General Medicine Medical Sub-Specialties Pediatrics EENT Surgical Services % Events % Indemnity Paid 41% 45% 23% 22% 18% 15% 6% 5% 7% 8% VISUAL #12 - TOP CLINICAL SERVICES N=126 diagnostic-related events in the MD ofce with a surgical clinical service closed 2020-2024. See detail below.