The Cost of Diagnostic Delay and Error.

Abstract

For years, diagnostic delays and errors have been tolerated and often ignored, although they have been reported as a leading cause of patient harm.1 Beyond the evident impact on patient outcomes, there are limited data investigating the effect of such delays and errors on health care expenditure. The National Academy of Medicine estimates that $750 billion, or 30% of annual health care spending, is wasted in unnecessary services and other inefficiencies,2 but the contributions of diagnostic error to these excess costs remains uncertain. For this edition of Bending the Value Curve, we present a case that highlights the impact of a diagnostic delay on health care use and expenditures and illustrates factors contributing to the delay. Verbal informed consent for writing this report was obtained from the patient and his guardian. A 17-year-old boy presented to his primary care physician with rectal pain, intermittent rectal bleeding, and loose stools. He denied abdominal pain, fever, weight loss, or sexual activity, and his physical examination revealed anal tenderness to palpation, with no visible tears, bulges, or lesions. He was prescribed escalating treatments for possible hemorrhoids but had minimal improvement over 2 weeks. After a telehealth consult with gastroenterology (because of coronavirus disease 2019 [COVID-19] restrictions at the time), blood and stool samples were obtained for workup of inflammatory bowel disease (IBD), celiac disease, and infectious colitis, and urine samples were sent to evaluate for sexually …