Connecting the Dots

Humans have been connecting the dots since the earliest declaration that a collection of stars resembles an animal or hunter or a flying horse. Magazines and even game shows turned the practice into entertainment and, eventually, the act of joining disparate points to depict a bigger picture became synonymous with problem solving, such as making a medical diagnosis.

From a patient safety perspective, it is the failure to recognize and connect relevant dots: signs, symptoms, test results, etc., that is often cited in adverse events and medical malpractice allegations. While the most common risk is missing or delaying a diagnosis, a failure to appreciate key physiological indicators can also hinder ongoing medical treatment and impede post-op recovery.

A review of 40,000 closed medical professional liability (MPL) cases from the Candello database indicates that 17% were impacted by the failure of one or more clinicians to recognize the clinical picture from the available information including patient history, reported symptoms, physical examination, and test results. In other words, there was a failure to connect the dots of clinical information to help see the bigger picture of the patient’s diagnosis, status, or prognosis.

More than half of MPL cases in which this factor (and most often, concurrent contributing factors) impacted the patient's care were closed with an indemnity payment. The average payment ($584,000) is considerably higher than the average for all paid cases ($437,000) in this analysis. That is likely due to the higher percentage of diagnosis-related cases (38% vs. 20%) which tend to be more costly to resolve.

Clinicians have to navigate many (well-documented) pitfalls throughout their routine patient care processes, including the predominantly harmless heuristics they use to save time and money when faced with indicators that might raise an eyebrow, but not an alarm. Anchoring on a diagnosis, assuming that a certain symptom or test result is an anomaly, bypassing the patient’s history, determining that subsequent providers don’t need to be told about X, Y, or Z are just a few of the ways truly informative dots are not connected and a clear picture of trouble is missed.