Improper Diagnosis is a Medical Error

Course excerpt from Preventing Medical Errors in Behavioral Health

Preventing Medical ErrorsClearly, the failure to arrive at an accurate diagnosis – or diagnoses, in many cases – can be a leading cause of error in behavioral health care. According to the introductory section of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), (American Psychiatric Association, 2013), “Reliable diagnoses are essential for guiding treatment recommendations, identifying prevalence rates for mental health service planning, identifying patient groups for clinical and basic research, and documenting important public health information such as morbidity and mortality rates” (p. 5).

While DSM-5 is the latest effort on the part of the American Psychiatric Association, using it is not a simple matter. The introductory section of DSM-5 (p. 5) goes on to state: “Clinical training and experience are needed to use DSM in determining a diagnosis. The diagnostic criteria identify symptoms, behaviors, cognitive functions, personality traits, physical signs, syndrome combinations, and durations that require clinical expertise to differentiate from normal life variation and transient responses to stress.”

To make matters even more complex, DSM-5 recognizes that the latest formulations of mental disorders now conceptualize “many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors, and possibly shared neural substrates… In short, we have come to recognize that the boundaries between disorders are more porous than originally perceived” (p. 6).

Porous boundaries? One example of this is the DSM-5 category autism spectrum disorder, formerly split into the DSM-IV categories of autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified. DSM-5 instructs that individuals formerly diagnosed with one of those DSM-IV categories should now be given the diagnosis of autism spectrum disorder. There is one residual category that can be used for individuals who have “marked deficits in social communication, but whose symptoms do but otherwise meet criteria for autism spectrum disorder” (American Psychiatric Association, 2013, p. 51). That category is social (pragmatic) communication disorder.

The point here is that the failure to make an accurate diagnosis can be a significant source of error in mental health practice. Diagnosis is challenging on its own, but as time goes on and diagnostic conceptualizations change, clinicians have to engage in perpetual study and training or risk falling behind. Risk areas include inadequate familiarity with contemporary diagnostic science, failure to detect the presence of multiple pathologies, and insufficient cultural competence in caring for culturally diverse patients and families. All of these areas can be addressed by training, experience, and clinical supervision.

Preventing Medical Errors in Behavioral Health is a 2-hour online continuing education (CE/CEU) course intended to increase clinicians’ awareness of the many types of errors that can occur within mental health practice, how such errors damage clients, and numerous ways they can be prevented. Its emphasis is on areas within mental health practice that carry the potential for “medical” errors. Examples include improper diagnosis; breaches of privacy and confidentiality; mandatory reporting requirements; managing dangerous clients; boundary violations and sexual misconduct; the informed consent process; and clinical and cultural competency. There are major new sections on psychotherapy in the digital age, including the use of social networking systems, the practice of teletherapy, and the challenges of maintaining and transmitting electronic records. *This course satisfies the medical errors requirement for license renewal of Florida mental health professionals. Course #21-03 | 2015 | 28 pages | 14 posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

 

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