Mythology of Personal Injury: Failure to Diagnose


In the medical/legal arena, there is the illusion that medical doctors know everything. For those who have gone into a specialty, they clearly do know more about that particular body part or function of their specialty. Overall however, research is clear, the leading cause of malpractice is failure to diagnose.

I have often taught that personal injury is not healthcare. I then go on to teach that personal-injury is injury care and if you do not know how to diagnose all of the injuries in a motor vehicle collision you would do well to check on your malpractice coverage.


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The greatest challenge in healthcare is having the skills and experience to be able to diagnose all of the injuries. Unfortunately, most medical doctors are ill equipped to evaluate musculoskeletal injuries. Their general education focuses on diagnosing diseases rather than injuries.
For those who choose to specialize in emergency care or orthopedics there is a greater understanding of musculoskeletal anatomy.

Unfortunately again, studies as far back as 1998 have made it clear that even for those who study orthopedics, musculoskeletal education in our medical schools is inadequate.

Nelson Hendler, MD, a retired neurosurgeon, researcher and past president of the American Pain Society did several studies on failure to diagnose. Cases that had been referred to his group at Johns Hopkins were reevaluated.


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In the first study with 60 subjects, he found that 67% were misdiagnosed and half of those required a surgical procedure.

In a second study with 80 subjects, 40% of them were found to have been misdiagnosed. Of those who were misdiagnosed, 55% required surgical procedures. I will grant you that a facet injection is a surgical procedure even if it is performed with a needle. Of course, when you get to present the size of that needle to a jury it does have impact.

Hendler did a third study that went so far as to find that 80% were misdiagnosed. For the most part the diagnosis provided by medical doctors was a cervical or lumbar strain. This is commonly seen in notes from the Emergency Department or from an IME.

Strain refers to a muscle injury and because of its abundant blood supply. Muscles do tend to heal quickly. This is the basis for the insurance industry contending that your client should have healed in 6 to 8 weeks.


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With a proper diagnosis that begins with a sprain, the focus now shifts to damage to ligaments and discs. These do not heal as well if at all. These will have permanence.

Ironically, chiropractors in the state of Arizona by statute are the one healthcare profession that by definition is specifically qualified to diagnose neuro-musculoskeletal issues. Those chiropractors who have completed the 150-hour certification in motor vehicle injuries are eminently more qualified to determine all of the injuries in a motor vehicle collision. These include specifics as to which joints in the spine are involved, and their effect on other parts of the body. These also include an actual cranial nerve examination that will find and document multiple injuries in a concussion/traumatic brain injury.

I do not hesitate to teach my chiropractors the importance of working with medical professionals and specialists who can address injuries that may go beyond their knowledge or experience. Having an MD on a case always adds value for an attorney. Having a DC who knows how to diagnose and treat all of the injuries adds more value to the patient.

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