A survey of outpatient Internal Medicine clinician perceptions of diagnostic error

Abstract

BackgroundLittle is known about how practicing Internal Medicine (IM) clinicians perceive diagnostic error, and whether perceptions are in agreement with the published literature.MethodsA 16-question survey was administered across two IM practices: one a referral practice providing care for patients traveling for a second opinion and the other a traditional community-based primary care practice. Our aim was to identify individual- and system-level factors contributing to diagnostic error (primary outcome) and conditions at greatest risk of diagnostic error (secondary outcome).ResultsSixty-five of 125 clinicians surveyed (51%) responded. The most commonly perceived individual factors contributing to diagnostic error included atypical patient presentations (83%), failure to consider other diagnoses (63%) and inadequate follow-up of test results (53%). The most commonly cited system-level factors included cognitive burden created by the volume of data in the electronic health record (EHR) (68%), lack of time to think (64%) and systems that do not support collaboration (40%). Conditions felt to be at greatest risk of diagnostic error included cancer (46%), pulmonary embolism (43%) and infection (37%).ConclusionsInadequate clinician time and sub-optimal patient and test follow-up are perceived by IM clinicians to be persistent contributors to diagnostic error. Clinician perceptions of conditions at greatest risk of diagnostic error may differ from the published literature.

Impact of System and Diagnostic Errors on Medical Litigation Outcomes: Machine Learning-Based Prediction Models

“…These results are consistent with those of previous studies on internal medicine and orthopedic surgery [5,8,12]. Various previous studies have estimated that physician diagnostic errors in the outpatient setting may range from 3-10%, and the negative impact of diagnostic errors is a significant and urgent problem that needs to be addressed [9,30]. Thus, it is reasonable to understand that medical errors (system and diagnostic errors) are related to litigation outcomes.…”

Defining Diagnostic Error: A Scoping Review to Assess the Impact of the National Academies’ Report Improving Diagnosis in Health Care

“…Two surveys on clinicians’ perceptions of diagnostic errors were identified. Matulis et al 35 conducted a survey of perceptions of outpatient internal medicine clinicians and included the NASEM definition on the survey itself, presumably including accuracy, timeliness, and communication. The primary care physicians’ survey by Donner-Banzhoff et al’s 34 operationalized error as cases where the original diagnosis later turned out to be wrong (e.g., a case in which an undesirable diagnostic outcome had occurred as defined by Olson et al 37 ) and treatment was delayed.…”

“…Of those included, 13 were U.S. studies, 2 were in Japan, and 1 was in Germany. Nine studies 20,23,24,26,29,30,32,33,35 indicated using the NASEM definition, 5 of those 20,23,24,30,32 operationalized it using a definition proposed before the NASEM report (see Table 3 for list of definitions). Three studies 21,31,34 operationalized error using existing definitions, and 4 studies 22,25,27,28 operationalized components of the NASEM definition (i.e., accuracy, timeliness, communication) for the purpose of the study and did not cite existing definitions.…”

Definitions and Measurements for Atypical Presentations at Risk for Diagnostic Errors in Internal Medicine: Protocol for a Scoping Review

“…Atypical presentations seem to be especially an important issue for diagnostic errors in internal medicine: first, atypical presentations may be commonly observed (up to approximately 30%) in the internal medicine department [ 13 ]; second, internal medicine physicians consider atypical presentations to be the most important contributor to diagnostic errors in their clinical practice [ 18 ]; and third, atypical presentations can be an important contributing factor to a higher prevalence of diagnostic errors in internal medicine [ 10 , 13 ]. Therefore, a comprehensive understanding of the association between atypical presentations and diagnostic errors is required.…”