A Pseudoepidemic of Postoperative Scleritis Due to Misdiagnosis

Abstract

The art of clinical diagnosis involves the subjective interpretation of clinical history, physical findings, and laboratory results. A repeated error in the interpretation of clinical findings can simulate an outbreak of disease. Clinicians may be reluctant to concede misdiagnosis.

Pseudo outbreaks and no-infection outbreaks (part 2)

“…Twenty-one patients were misdiagnosed with postoperative scleritis over a two-month period in a US outbreak (Burwen et al, 1999). The CDC were called in to assist and in extensive investigations searched for pre, intra, and postoperative exposures -none were found.…”

“…What happened is described above using Reason's (2000) error categories (Table 3). Direct quotes taken from the paper are marked (Burwen et al, 1999).…”

“…To those of us who are impelled to annotate papers with symbols or letters denoting that this is a paper of such quality, depth and or insight, I will need to refer to it many times – the next paper got my top score (3 stars). Twenty-one patients were misdiagnosed with postoperative scleritis over a two-month period in a US outbreak (Burwen et al, 1999). The CDC were called in to assist and in extensive investigations searched for pre, intra, and postoperative exposures – none were found.…”

“… The authors stated that the ‘pseudo’-outbreak could have been described as an epidemic of poor surgical technique had the clinical findings not been interpreted as infectious scleritis. (Burwen et al, 1999). …”

A pilot study in ophthalmology of inter-rater reliability in classifying diagnostic errors: an underinvestigated area of medical error

“…11 Investigation into epidemics of misdiagnosis due to multiple time clustered errors of diagnosis reveals institutional and professional pressure not to report such events. 12 As a consequence, it is likely that serious diagnostic errors are underestimated. Physicians who are tested using ''real life'' clinical simulations commit a substantial number of errors in clinical reasoning (resulting in misdiagnosis) at all stages of training and experience, suggesting that similar mistakes occur in clinical practice.…”