Diagnostic Errors in Primary Care: Lessons Learned

Abstract

Background: Diagnostic errors occur more commonly than other kinds of errors, they are more likely to harm patients, and they are more likely to be preventable. Little is known about the presenting complaints, initial (incorrect) diagnoses, and physicians' personal lessons learned related to diagnostic errors.Methods: In 2009 and 2010, we invited a random sample of 200 family physicians, 200 general internists, and 200 general pediatricians practicing in Iowa to describe an important diagnostic error using a 1-page, mailed questionnaire. The data were analyzed using quantitative and qualitative methods.Results: The response rate was 34% (202 of 600 physicians). Common presenting complaints included abdominal pain (n ‫؍‬ 27 of 202 patients, 13%); fever (n ‫؍‬ 19; 9%); and fatigue (n ‫؍‬ 15, 7%). Common initial (incorrect) diagnoses included benign viral infections (n ‫؍‬ 35, 17%); musculoskeletal pain (n ‫؍‬ 21, 10%); and chronic obstructive pulmonary disease/asthma (n ‫؍‬ 13, 6%). The 202 responding physicians described 254 personal lessons learned, which we used to develop a taxonomy of 24 generic lessons. Three common lessons were: (1) consider diagnosis X in patients presenting with symptom Y (n ‫؍‬ 37 lessons, 15%; eg, "Any discomfort above the umbilicus may be coronary artery disease."); (2) look beyond the initial, most obvious diagnosis (n ‫؍‬ 26 lessons, 10%); and (3) be alert to atypical presentations of disease (n ‫؍‬ 24 lessons, 9%).

Patient safety in primary health care: a systematic review

“…There was a balance in the yearly distribution of the articles' publication: four in 2007 9,10,11,12 , six in 2008 13,14,15,16,17,18 , three in 2009 19,20,21 , ten in 2010 22,23,24,25,26,27,28,29,30,31 , six in 2011 32,33,34,35,36,37 and four in 2012 38,39,40,41 (Table 2).…”

“…The study population consisted of physicians and other health professionals 9,10,13,14,15,16,19,20,22,24,25,28,30,32,33,34,35,36,39,40 , patients and families 26 , and health professionals and patients and families 11,21,23,27,29,31,41 , while in some studies the study population was not described in complete detail 17,22,38 (Table 2).…”

“…Eight studies 13,14,15,17,21,27,32,34 aimed to identify the types and severity of incidents in primary care and their contributing factors; 19 studies 9,11,16,18,19,20,22,23,24,25,26,29,30,33,35,37,39,40 aimed to indicate solutions to make primary care safer for the patient; and six studies 12,28,31,36,38,41 aimed to evaluate the tools for improving patient safety in primary care.…”

“…Some studies used interviews to obtain data, either with physicians 25,33,39 or with physicians and other health professionals 24 . Questionnaires were also used by some authors to extract data, and were answered by physicians 22,40 , physicians and other health professionals 10,16,28,34 , or patients and family members 26,27 . Other studies used a combination of methods for data sources: incident reporting systems, direct observation, and focus groups 35 ; incident reporting systems, direct observation, and interviews 11 ; direct observation with audio recording 29 ; direct observation and expert consensus 36 ; incident reporting systems, patient file review, and interviews 41 ; incident reporting systems and patient file review 21 ; incident reporting systems, interviews, and questionnaires 30 ; expert consensus, questionnaires for patients, and focus groups 31 ; incident reporting systems, patient file review, and questionnaires 41 (Table 2).…”

Staying Out of Trouble

“…The correct diagnosis had not initially occurred to the studied physicians 82 % of the time [16]. Four patients were originally diagnosed by their doctors with gall bladder disease.…”