Detailed Instructions: In this task, you are given a text of many news articles seperated by special token "|||||". Your task is to summarize them.
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 At least one in every 20 adults who seeks medical care in a U.S. emergency room or community health clinic may walk away with the wrong diagnosis, according to a new analysis that estimates that 12 million Americans a year could be affected by such errors. 
  
 Of those misdiagnosis mistakes, about 6 million could potentially cause harm, according to patient safety expert Dr. Hardeep Singh, who is the first to provide robust population-level data on the impact of the problem in outpatient settings. 
  
 That means patients with conditions as varied as heart failure, pneumonia, anemia and lung cancer could have serious problems that remain unrecognized by a doctor, according to the study published Wednesday in the journal BMJ Quality and Safety. 
  
 “What we say is, was there a missed opportunity? Was there some kind of a red flag?” said Singh, a researcher at the Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, the Michael E. DeBakey VA Medical Center and Baylor College of Medicine. 
  
 Quantifying such errors has been difficult, largely because researchers don’t all use the same definition for mistakes and it’s hard to track cases across multiple providers over time. 
  
 But it’s been a laser focus for Singh, who this week received the prestigious Presidential Early Career Award for Scientists and Engineers from President Barack Obama for his work on missed diagnoses and patient safety. 
  
 “What we say is, was there a missed opportunity? Was there some kind of a red flag?” 
  
 In the new study, Singh and his colleagues used data from three previous studies that focused on unusual patterns of return visits after primary care visits, lack of follow-up for abnormal findings related to colorectal cancer and consecutive cases of lung cancer. They were based on electronic “triggers” of errors in records at two large health care systems in 2006-2007 and reports of lung cancer at two institutions. Because they were conducted by Singh’s own research teams, the definitions were consistent and allowed for precise analysis and estimates. 
  
 What they found was that in a little more than 5 percent of cases, the original diagnosis was wrong — and could have been accurately detected by the information available in the first setting. 
  
 “It is surprising — 5 percent,” Singh said. “Yet on the other hand, this evidence has been coming together.” 
  
 Previous studies had hinted that the rate of outpatient misdiagnosis might be that high, or even higher. In fact, Dr. Gordon Schiff, a patient safety expert at Brigham and Women’s Hospital in Boston, said that he believes Singh’s work probably underestimates the actual scope of diagnostic errors. 
  
 “I think it does give us a good a hard number. Previously, we had softer numbers,” he said. “But the numbers probably overlook other error activity. I would say this is a minimum.” ||||| The analysis looked at triggers which detected unusual patterns of return visits and hospitalizations, and lack of timely follow-up for patients who were later diagnosed with disease.More than 5%, or about 12 million U.S. adults, could be misdiagnosed during an outpatient visit, the researchers concluded, and about one-half of these errors had the potential to lead to worse outcomes for the patients.“The numbers are a bit surprising when you put it at the population level, said Dr. Hardeep Singh, lead author of the study and a researcher at the Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, based in Houston. “Diagnostic errors have been difficult to measure, but when you put these findings in context with the emerging evidence about this problem over the past few decades, it really makes sense.”One of the studies used in the analysis, published in March 2013 in JAMA Internal Medicine , identified nearly 70 different conditions for which misdiagnoses occurred in the primary-care setting, like pneumonia, renal failure and urinary tract infections. The other two focused specifically on cancer, including a retrospective study published in BMJ that used electronic health-record data to detect potential delays in prostate and colon cancer diagnoses; and a 2010 study in the Journal of Clinical Oncology , which evaluated whether EHRs could be good predictors of misdiagnoses in lung cancer.The reasons for the high numbers of “missed opportunities” are multifaceted, experts who spoke with Modern Healthcare explained. They cited concerns around various items within the healthcare setting, like the structure of outpatient systems, cognitive biases and unclear clinical guidelines. It will take more than one approach to make improvements.“This is a hidden problem,” said Dr. David Newman-Toker, director of initiatives for diagnostic safety and quality with the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, Baltimore. He agreed with the authors, who said the study's limitations may mean the numbers of misdiagnoses might be underreported.“Although this may numerically be the biggest patient-safety problem, it's the bottom of the iceberg,” he said. Efforts to make improvements in other areas—like wrong-side surgeries and hospital acquired infections—have really taken off, but there is very little reporting on diagnostic error, Newman-Toker explained.Others pointed to concerns with the way primary care is structured in the U.S. healthcare system.“Doctors just don't have much time,” said Dr. Otis Brawley, chief medical officer for the American Cancer Society.Physicians often have eight to 10 minutes to make clinical decisions, he says, and are therefore forced to make decisions without complete information or with incompletely digested information. For example, colon cancer can easily be missed initially, he said, because patients often show up with symptoms like a stomach ache or diarrhea, which can be associated with other conditions.“The pressure to move patients in and out and the resulting brief clinical interactions between doctor and patients is a situation that fosters medical errors,” Brawley said.Unclear guidelines and limited diagnostic options, might also present challenges that lead to some frequently misdiagnosed conditions.“With regard to lung cancer, early detection is our biggest problem,” explained Dr. Norman Edelman, senior medical adviser for the American Lung Association. CT scans are better at identifying potential lung tumors than routine chest X-rays, Edelman said, but every nodule that might be identified on a scan should not be biopsied.“You'd be doing an invasive procedure on too many people,” he said. “That would be overdiagnosis.”Efforts to measure and reduce diagnostic errors should be a bigger focus for policymakers, healthcare organizations and researchers, the authors of the new report conclude. The difficulty, Singh said, is that it takes multiple factors working together to make the improvements.Concerns over the lack of focus on diagnostic errors were shared by many of the experts, including Newman-Toker.“It's one thing to sound the alarm, but we're talking about potentially preventable misdiagnoses. There was a chance to do things differently,” he said.Diagnostic errors accounted for the largest fraction of malpractice claim payouts, amounting to $38.8 billion between 1986 and 2010, according to a study he authored last spring “This is an issue that merits a lot more attention than it has gotten,” he said. “It's a major public health problem.”Follow Sabriya Rice on Twitter: @MHSRice |||||
A:
American doctors misdiagnose roughly one out of every 20 adult patients they see in an outpatient setting, or about 12 million of us a year—and about half of those mistakes could cause serious harm, according to a new research report. A team led by Dr. Hardeep Singh—who recently won the Presidential Early Career Award for his work in this area—examined three previous studies, also conducted by Singh's team, that looked for error triggers at two major health care systems, like unusual return visit patterns, NBC News explains. And those three studies "yielded a rate of outpatient diagnostic errors of 5.08%," per the report. "It is surprising—5%," Singh says of the percent of cases where the first diagnosis was wrong, but the information for a correct diagnosis was present. And one patient safety expert sees that figure as conservative. "I would say this is a minimum." Experts tell Modern Healthcare that there are likely numerous reasons for the lapses, among them the way primary care is structured in the US. "Doctors just don't have much time" due to "the pressure to move patients in and out," an American Cancer Society official points out, noting physicians typically have just 10 minutes to arrive at their diagnosis. But doctors have a vested interest in somehow improving the system: Misdiagnoses were the number one source of malpractice claim payouts from 1986 to 2010, according to a recent study.