Risk of Medical Error Doubles if You Have a Psychiatric Diagnosis

More than 40 million people a year experience adverse effects from medical error.


According to researchers, about 10% of all medical interventions result in direct harm. More than 40 million people a year experience adverse effects from medical care.

In a new study, researchers tried to determine what factors increased the risk of experiencing a preventable medical error. They investigated cases of preventable harm in primary care settings and the emergency departments of hospitals. They found that having a psychiatric diagnosis was the largest risk factor, doubling the risk of preventable harm. The researchers write:

“Psychiatric disease, including all psychiatric diagnoses regardless of severity, nearly doubled the risk of being a reported case of preventable harm (odds ratio, 1.96; p < 0.001).”

The most common type of preventable harm was diagnostic error, in which doctors missed or misdiagnosed cases of physical illness. The majority of the psychiatric diagnoses were depression and anxiety.

The research was led by Rita Fernholm at Karolinska Institutet, Sweden, and published in BMC Family Practice. The study included 4536 people with reported preventable harm from medical interventions. Each participant was matched with ten controls (people of the same age, sex, and residential area who had no reported medical harm) for comparison. The study was conducted in Sweden.

The researchers hypothesized that low socioeconomic status and being from another country might also lead to more cases of preventable harm. However, these factors only had a slight impact, which paled in comparison to having a psychiatric diagnosis.

Education level and income only made an impact when the lowest possible ratings were compared with the highest possible ones. In some cases, there were very few participants who matched the criteria, making comparisons tentative. Surprisingly, being born in another country slightly reduced the risk of medical error, although being born in Sweden of two foreign-born parents slightly increased the risk.

According to the researchers, a potential reason for their finding may be that “physical symptoms are misattributed to mental illness.” The researchers call this “diagnostic overshadowing.” That is, patients may describe physical complaints, but doctors may dismiss them as part of the person’s “mental illness.”

This may be one reason why people with psychiatric diagnoses are almost twice as likely to die within 15 days of being released from emergency departments. The researchers write:

“Patients with psychiatric illness are at higher risk of preventable harm in primary care and the emergency department. Therefore, this group needs extra attention to prevent harm.”




Fernholm, R., Holzmann, M. J., Wachtler, C., Szulkin, R., Carlsson, A. C., & Härenstam, K. P. (2020). Patient-related factors associated with an increased risk of being a reported case of preventable harm in first-line health care: a case-control study. BMC Family Practice, 21(20). https://doi.org/10.1186/s12875-020-1087-4 (Link)


  1. Ah the good old “unintended negative outcome”. It’s a three card monte.

    I may have the means and opportunity, but minus a confession of motive you can not demonstrate that I meant to harm you. Thus what was a deliberate act to cause harm becomes an unintended negative outcome. And why would anyone be looking to provide extra attention to mental patients when thy spend so much time and effort NOT providing any attention to mental patients, and in fact turning their backs on them? Seems counterproductive if you ask me.

    “The most common type of preventable harm was diagnostic error, in which doctors missed or misdiagnosed cases of physical illness. The majority of the psychiatric diagnoses were depression and anxiety.”

    And of course it could not have been diagnostic error in the case of psychiatric diagnoses because they are made up illnesses and can neither be proven or disproven. Pretty easy to show that a doctor misdiagnosed Athletes Foot as being Syphilis and rang your wife a little earlier than he should have. Whereas with mental illnesses I was given a diagnosis of three serious ones and within two hours had been cured according to the documents I have. Thus it wasn’t a mistake or error but really good doctoring (or maybe it was the fact that the benzos from being “spiked” without my knowledge had worn off? The things one has to do to plant evidence and obtain a police referral these days huh)

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    • “I may have the means and opportunity, but minus a confession of motive you can not demonstrate that I meant to harm you.”

      In the good ole US of A, even if you have proof in medical records of the doctors’ motive(s), you can’t find a lawyer who’ll take the case, if you’ve been misdiagnosed with any of the “invalid” DSM disorders.

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  2. The medical doctors themselves even in ER will now gladly jump on board to not only participate in being discriminatory towards those wrongly labeled, which of course means that ALL labels are bogus.
    If they were not pure bogus, it would NEVER result in those labeled to receive the garbage they receive from other establishments.

    Also, medical doctors now give people a psych diagnosis, by scribbling innuendos into their charts. Those innuendos are done with absolute knowledge of what they will accomplish.

    Proving we do not need shrinks at all, the Medical community and the floor cleaners at hospitals can now “note” whatever they need to do in their freaked out, paranoid minds.

    They think they hold the last bit of power. They do not. Death holds that.

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  3. Well, it finally occurred to someone that physical illnesses might have “mental” diagnostic symptoms. Maybe it finally might be a good idea for psychiatrists to keep up on what physical diseases might have these alleged mental symptoms. (Do you suppose the unthinkable might be true?)

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  4. Yep. It doesn’t help that the psych treatments cause so many additional health problems either.

    Even militant psychiatry apologist “Natasha Tracie” at Bipolar Burble has complained of how doctors dismiss her real health problems after learning of her “bipolar” label.

    My guess is most doctors simply don’t care if those psychiatry has written off as “defective” die. Our culture has less mercy on the disabled (especially mentally) than convicted felons considered sane.

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      • You called it right, medical proof of a “bad fix” on a broken bone, at which my pill pushing PCP’s husband was – unbeknownst to me, until I picked up medical records years later – the “attending physician.” That certainly was malpractice.

        I believe it’s called covering up easily recognized iatrogenesis, with controversial iatrogenesis (psychiatric drugs).

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      • the psych diagnosis are malpractice. The docs that still giggle at psychiatry now present it as valid. It helps a ton in the circles of medicine, where many real illnesses can’t be discovered or identified or helped, due to scant science.
        I have yet to figure out why medic9ine is so comfortable.
        I can only deduce that there is that empathy bit missing, it never calls to them and if it does, they quickly try to snuff out the light.
        Might be why MI is always involving emotion.
        And I have yet to figure out why all those MI have not gone vigilante on the killers that our laws wil not and refuse to deal with.

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    • I really need to write an actual blog about my experience of abuse at the hands of our local medical umbrella corporation. In my area, one corporation pretty much owns every medical practice nearby, including our new hospital.

      I am a Psychiatric Survivor. I spent about 8 years on various combinations of psychiatric meds, in combination with an active drinking problem! The psychiatrists knew of this problem. But somehow they thought my mental state would improve with the addition of up to 8 psych drugs in combination with my intoxicated baseline. At one particularly memorable detox at our local hospital, the on-call psychiatrist saw me for 10 minutes – again, actively detoxing from alcohol – and decided I was bipolar. I have never been manic in my life. Not once. He also thought that I had borderline personality disorder because I didn’t bow down and worship his expertise. These new diagnoses, of course, came with additional meds. That was in May of 2015 and was the beginning of my questioning just who the crazy ones were in this system. I came out of that detox with 8 meds, 3 of them newly prescribed, one of them being lithium! For an active alcoholic. I had already dropped 4 of them by the time I entered my final detox in October of 2016. After that, I gradually tapered off the last 4. It sucked. It was hell. And I’m not sure I am without damage to this day. But I am so much better now. I am functional. I am also no longer an alcoholic. I drink like six times a year now. It took getting off the psych meds to be able to do that, to make it worthwhile. If I was going to feel like total crap anyway on all the meds, drinking made more sense. When I felt better, I wanted to feel even better. So I drastically curtailed my alcohol intake and reengaged with my family, fighting for care for my daughter and for my aging parents.

      I also had a boatload of trauma, of course: Sexual assault in high school, domestic violence, and being ripped away from my career to care for a severely disabled child with autism, intellectual disability and some probably bullshit additional psychiatric diagnoses. I became utterly dependent on my husband financially and subject to his anger management and control issues, which were his way of coping with the trauma and bereavement related to our daughter’s conditions.

      What I needed was a social safety net that provided adequate support to a family with a severely disabled child with dangerous behaviors. What I needed was independence and the ability to support myself so that I could hold some power over my circumstances. Instead, I became a full-time, unpaid behavioral therapist in our little asylum until I lost my own sanity and just existed in self-imposed alcoholic lockdown. What I needed was informed trauma care. What I didn’t need was bullshit 12-step-based religious cult nonsense that added additional trauma and unhelpful labels and disempowering dogma. What I didn’t need was the sedation and iatrogenic illness of a truly bewildering array of psych meds.

      The continuing hell is this: Those diagnoses NEVER go away. Even when you actively fight to amend your medical record, you cannot remove those biasing diagnoses entirely. Medical software that supposedly the entire umbrella corporation uses ensures those diagnoses reside forever somewhere on your chart. Records you send to other providers, specialists, contain: depression, alcoholism, anxiety, etc. They aren’t listed as “Historical.” They are still in your “Current Problems,” because the practice never updates its records, never downloads your actual current list of conditions. The entire corporate system is aware of these limitations, but sees it as too big a problem to solve. Besides, alcoholics and the mentally ill never get better, right?

      Those diagnoses lead to medical practitioners assuming your every complaint is psychiatric in origin. It took almost four years to get diagnoses of hypothyroidism, hyperparathyroidism and an ascending aortic aneurysm of 4.8 cm. I do not know how long I have had the aneurysm and that one is particularly dangerous. If it ruptures, I am likely dead almost instantly. But, of course, when I present at the ER with heart symptoms, they do a troponin test and a quick ECG, maybe a chest x-ray. Since I’m not having a heart attack, my symptoms are put down to “panic attack induced by stress.” They never looked further until I had a recent episode and demanded a nuclear stress test, which revealed the aneurysm.

      These B.S. psych diagnoses do not go away and they are killing people. You have to be willing to be assumed to be ‘crazy,’ to be documented as being ‘crazy,’ to push for the healthcare you need to save your life. You have to get really comfortable with confrontation. You need to reach out to local mental health advocacy services, to file complaints with HHS – OCR (Office of Civil Rights under the ADA), and keep documenting. Make your doctors put in writing their refusal to treat. That will usually get them to back down. They know they’re wrong. They know they are discriminating against you. They won’t want it documented.

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      • Feral,
        Thanks for saying how it is.
        One does not even need a “diagnosis” for any of these maltreatments. If one doc even writes those innuendos, which they refer to as opinion, game over.
        It is a club of adherence to their own pack. It is basically like being called a bad person by a few church members, who spread the word and you will never be seen as a good person again. Even if a few members know it’s wrong, they feel pressured and their self identity is most important.

        Psychiatric innuendo has been a huge crutch for medicine. It comes in handy in a world where many of the medications for ailments, especially chronic and not fixable, fail. Many of the new docs coming in are not at all interested in thinking or truly ministering. This has led to many docs taking out their frustrations on patients. It is clear that medicine expects people to suffer like stoics do.
        And anything not stoic is anxiety, panic or depression, which are of course MENTAL ILLNESSES. Overwhelm, anguish, tears and fears are Mental illnesses. If they are super kind, tHey will write down “psychological” and refer you to a CBT team led by more dense kids that have no idea of illness or life period.
        No one tells informs these medical school kids that they are always going to be uninformed about their patients, and that within that space of not knowing is not the space where you damage the patient by leaving innuendos for others to read.
        They know it’s gossip, they know how it’s viewed, yet they do it anyway.
        And they also know that it’s A crock of shit.

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  5. I was misdiagnosed with “suspected autoimmune encephalitis” at the Mayo Clinic. The Mayo prescribed empirical treatment was weeks of IV steroid and IVIG infusions. I went into severe shock due to an adverse reaction during one of the IVIG infusions. The infusions only made my symptoms worse. The real cause of my illness? Benzo tolerance and withdrawal. I had to Google it. I had clearly told the Mayo neurologists that my psychiatrist was in the process of “slowly” tapering me off my benzo. When I later told my Mayo neurologist that I thought I was in benzo withdrawal and that I desperately needed help, I was told Mayo could not determine a definitive cause of my illness.

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  6. It seems important to distinguish between medical ERRORS (doing the wrong thing or overlooking something) vs. medical HARM (patient has a worse outcome despite following standard medical practice) vs. MALPRACTICE (doing something that the doctor knows or should have known is harmful, or failing to inform patients of risks of medical harm prior to treatment, etc.) Most medical harm is NOT due to errors, it’s due to adverse drug effects. And of course, those drug effects are MALPRACTICE if they result from neglecting to do proper differential diagnosis, or failing to provide proper informed consent to the patient. The medical profession has tried to reframe medical HARM as medical ERROR, even though most of the harm is done by standard medical practice. This appears to be an intentional effort to downplay the dangers and inadequacies of standard medical practice and to make it seem that failures and harm are due to a few “bad apples” rather than the standards of care being inadequate and frequently dangerous and corrupt.

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  7. Another issue that barely gets discussed is sensitivity to medication arising from past harm by psychiatric drugs. People who have had either adverse reactions or really severe withdrawal syndromes can wind up really sensitive to pills including some they may need for physical health issues.
    Some people wind up so sensitive they even report having adverse reactions to small amounts of vitamins.
    I don’t think I’ve ever heard of even one doctor who wanted to believe these sensitivities can occur too.

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  8. Neurologist wrote in my chart that I denied being depressed but expressed extreme guilt, very loaded questions to which I answered, “doesn’t everyone carry a little guilt for something?” Told me my right sided weakness, double vision and 24/7 occipital headache was due to a depression I didn’t realize I had. I had a different doctor order an MRI and lumbar puncture after having a medical professional in my family ask for it. Wouldn’t you know, it was in my head….a virus! I find it very hard to trust doctors as I had to fight to get someone to even check for what was a very serious and worsening condition. The assumptions were made because I had a rare virus and he had access to pharmacy records and what those psychs did years before.

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  9. There are serious, serious, serious medical consequences to having a diagnosis. You are, quite simply, not listened to, and your needs are almost NEVER taken seriously. Something needs to be done to seriously, seriously, seriously reform the system, soup to nuts.

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  10. I just took my son with a “psych diagnosis ” to our GP with what looks to me as a 30year experienced health care professional as a skin cancer on his foot and was summarily dismissed.. Good try everyone ..someone explain that to me other than no one other than me gives a rats arse.. When I call myself mad that is a euphemism for mad as hell, angry , really really pissed of that this boy’s life counts for nothing . Not one of you morons here will reply because Matt was the only one that ever did shame on you all

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    • @madmother13 – so what did you do?

      I liked Steve McCrea’s differentiation of:

      MEDICAL ERROR – woops, we goofed (but they never admit it – “pt didn’t respond to treatment” is usually how that gets charted)

      MEDICAL HARM – the treatments cause damage

      MEDICAL MALPRACTICE – negligence and malfeasance, which, in the case of psychiatry, is because of error (diag-nonsense) and harm built into the “treatments”

      So – I have a number of “diagnosed” friends, and once that diagnosis is there- MD’s think everything is related to psych. Perhaps they looked at your son’s cancer and thought, “hygiene.” blah blah blah.

      I have a similar issue with fat. People who are overweight go to doctor, and doctor blames everything (cholesterol, arrhythmia, pain, endocrine, fatigue, blah blah blah) on “well, if you’d just lose weight. . . . ” (gosh, Doc, why didn’t I think of that?)

      It’s a bias, a prejudice, and an unconscious one.

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  11. This is a sickening reality that has not been exposed enough. The study found it was mostly labels of depression and anxiety that doubles the risk of medical errors and misdiagnosis of physical symptoms, but it must be tenfold for labels of Bipolar, schizophrenia, BPD, and Somatization Disorder.

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    • It is sickening Rosalee, literally.
      I think the “labels” make no difference to them since it is nothing but a use of convenience. Anxiety is a favorite actually…it literally invalidates even suffering in death… I refuse to refer to made up names as “diagnosis”
      The med docs use psychiatry. In fact, no shrinks needed, as is evidenced by docs handing out drugs like candy.
      It is the lazy guys way out of actual responsibility, out of actual knowledge or having the fixes.
      Many illnesses can’t be fixed anyway, but what they have done to cope with it, is really embarrassing and pathetic.

      Most docs don’t do hospital deaths. They quietly go at home.

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  12. The Medicaid/state clinic PA gave me a second scrip for Lamictal after I reported a Neuroleptic Malignant Syndrome (NMS) reaction (historically my 2nd)-paralysis (and more) for 8 hours. I objected 3 times. He stood up and said ‘we’re done’. Still reeling from the ADR & withdrawal, I waited 3 more days & suffering…took it hoping for ANY relief.
    I woke up with crawling skin, ran to a mirror & my head was twice it’s size with bugging-out eyes. It was coming down my face. I made it to the ER with my RN brother. The doc wrote…..”POSSIBLE anaphylaxis'”(!)….but most importantly prescribed a Z-pac of Cort.
    As dismissive as he was when he knew my diagnosis of Bipolar & the drug that caused it, THAT vague description coupled with his ACTION, THE CORT…was proof of his deduction…& the beginning of my ‘negotiations’/blackmail of my psych handlers to get me out on my terms.

    2.5 years later I was off the drugs…a guided withdrawal… and OUT with the ‘changed’ diagnosis paperwork…Anxiety….to which I always reply-in my head or out loud…NO SHIT.
    I had to almost die (not the 1st time w/these guys) to craft a new life.
    The ‘luck’ and ensuing ‘Come to Jesus’ discussions that followed under withdrawal, rebound, and brain damage were the heaviest lift I would ever make, but…..
    Carpe Diem turned into Carpe Omnia.

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    • The problem with commenting on this is where to start?

      “Evidence based medicine.” How about any proof that the drugs work at all?

      By “work” I mean helping at thinking clearly, living independently, getting along with others, not dying prematurely or going through cognitive decline or suddenly becoming morbidly obese. No one in the mental illness system leads a high quality or longer life that I can tell.

      Yet numerous doctors claim that there’s no disputing what they see every day. THE MEDICATIONS WORK!!!

      How do they know this? Don’t they see the damage these drugs do to people long term? They must know these are slowly killing people.

      I have had NP’s who honestly seem to care diagnose me with mysterious ailments. Pernicious anemia, severe vitamin deficiencies, microscopic colitis, heart arrythmia, fatty liver, uncontrollable recurring yeast infections. But when I ask what’s behind them they grow silent and look weird. Yeah…they know.

      Funny how no doctor gets freaked out because I’m losing weight and my heart is normal again. These should be perceived as sure signs of “non compliance.” So there must be some ignorance involved too.

      Mom blabbed to her FNP that her daughter didn’t believe in “antidepressants” and had gone off of them. The nurse expressed horror and assured Mom that I would be sure to have a manic episode. With a straight face.

      Lucky for me Mom laughed at her. She’s been living with me and notices my moods are stable without drugs. 🙂

      And I thought SSRI’s were supposed to fix depression. Not mania. Neuroleptics are supposed to do that. Doctors need to work more closely with the Big Pharma propagandists to fill up the plot holes in their epic fantasy known as Mental Health.

      Yes. We should leave our echo chamber. But my stomach is already upset. Thanks to decades on SSRI’s that “work” at messing up my digestion.

      It’s pointless to argue with people that are living in a fairy tale. The medical student with “mental issues” may wonder why her magical meds aren’t working when she turns thirty-five and can no longer hold down a job because of cognitive decline and failing bodily systems. And everyone tells her how great her quality of life is–evidence to the contrary.

      Funny how extremely hostile “grateful consumers” can get at having the truth pointed out. I felt relief. Then anger at the people who had gaslighted and slandered me for twenty-five years. Not people who told me the (unpleasant) truth. I never was proud or happy of being “mentally ill” though. Some wear it like a badge of honor for reasons I can’t fathom.

      They’re invested in the System and make lots of money off it. So of course they want to preserve the status quo.

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  13. Just found this article, thank you Steve McCrea. I have delt with two sides of this. When I was in middle school, I developed Gastritis that happen to be caused by stress. I swore to the pediatric Dr that it was a physical problem, he did office exams, but kept telling me it wasn’t. He phoned a psychologist and urged me to see him. Once I started talking to the psychologist, less than a few months, my symptoms started to dissipate. Fastforward to a few decades later, I started getting bad acid reflux, was put on a terrible medication to help (made worse), and I was told by my primary DR. (who knows I have anxiety) that it’s anxiety, panic attacks etc… not the medication. I saw an ER DR prior (less dismissive), saying he was hesitant to say everything is anxiety. I know having a history of anxiety and presenting not the “typical” physical symptoms, is treated as very suspect (especially if those symptoms haven’t been diagnosed as proof).

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