Factors and impact of physicians’ diagnostic errors in malpractice claims in Japan

Watari, Takashi; Tokuda, Yasuharu; Mitsuhashi, Shohei; Otuki, Kazuya; Kono, Kaori; Nagai, Nobuhiro; Onigata, Kazumichi; Kanda, Hideyuki

doi:10.1371/journal.pone.0237145

Cited by 33 publications

(36 citation statements)

References 28 publications

(49 reference statements)

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“…In a previous study, upper gastrointestinal perforation was a common diagnosis, while colonic swelling, appendicitis, and pancreatitis were also reported [11]. The tendency for fatal diseases to be overlooked under the diagnosis of gastroenteritis in Japan is consistent with the nding of a previous study by Watari et al [19]. It is understandable that constipation is a common initial diagnosis due to the presenting characteristics of the patients.…”

Section: Discussionsupporting

confidence: 76%

Diagnostic Error Rates and Associated Factors for Lower Gastrointestinal Perforation: A Multicenter Retrospective Cross-sectional Study

Harada¹,

Watari²,

Watanuki³

et al. 2021

Preprint

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Lower gastrointestinal perforation is rare and challenging to diagnose timeously in the acute abdomen. However, no study has examined the frequency and associated factors of diagnostic errors related to lower gastrointestinal perforation. This large-scale multicenter retrospective study investigated the frequency of diagnostic errors and identified the associated factors. This study retrospectively analyzed data on patient factors, symptoms, situational factors, and physician factors across nine institutions between January 1, 2015 and December 31, 2019. Timely diagnosis was defined as diagnosis at the first visit to a computed tomography (CT)-capable facility or referral to an appropriate medical institution immediately following the first visit to a non-CT-capable facility; cases not meeting this definition were defined as diagnostic errors that resulted in delayed diagnosis. Of the 439 cases of lower gastrointestinal perforation identified, delayed diagnosis occurred in 138 cases (31.4%). Multivariate logistic regression analysis showed a significant association between examination by a non-generalist and delayed diagnosis. Other factors, such as presence of fever, absence of abdominal tenderness, and unavailability of urgent radiology reports, tended to be associated with delayed diagnosis. The initial misdiagnoses mainly comprised gastroenteritis, constipation, and small bowel obstruction. In conclusion, diagnostic errors occurred in about one-third of lower gastrointestinal perforation cases.

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Section: Discussionsupporting

confidence: 76%

Diagnostic Error Rates and Associated Factors for Lower Gastrointestinal Perforation: A Multicenter Retrospective Cross-sectional Study

Harada¹,

Watari²,

Watanuki³

et al. 2021

Preprint

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“…Although the most common initial diagnosis associated with allegations of diagnostic error was "no abnormality," after adjusting for the multivariate analysis findings, the only initial diagnosis with a statistically significant probability of causing the patient to win the case was "malignant neoplasm," suggesting that internists should be particularly careful when reporting a malignancy. Although some studies have examined the final diagnoses involved in medical malpractice claims in each clinical specialty (6,7,9,16,(19)(20)(21), few have investigated the later identification of the initial diagnosis from the perspective of diagnostic error (9).…”

Section: Discussionmentioning

confidence: 99%

“…Medical lawsuits are time-consuming and economically and psychologically burdensome. Several epidemiological and observational studies of the frequency of malpractice claims and the magnitude of awarded compensation indicate that diagnostic errors are a significant cause of medical liti- gation (5,(8)(9)(10)(11)(12). In general, it is difficult to estimate the actual frequency of errors from epidemiological studies' data of medical litigation because of selection bias in the trial process and in settlements.…”

Section: Introductionmentioning

confidence: 99%

Malpractice Claims of Internal Medicine Involving Diagnostic and System Errors in Japan

Watari

2021

Intern. Med.

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Objectives Medical litigation resulting from diagnostic errors leads to lawsuits that are time-consuming, expensive, and psychologically burdensome. Few studies have focused on internists, who are more likely to make diagnostic errors than others, with assessments of litigation in terms of system and diagnostic errors. This study explored factors contributing to internists losing lawsuits and examined whether system or diagnostic errors were more important on the outcome. Methods Data regarding 419 lawsuits against internists closed between 1961 and 2017 were extracted from a public Japanese database. Factors affecting litigation outcomes were identified by comparative analysis focusing on system and diagnostic errors, environmental factors, and differences in initial diagnoses. Results Overall, 419 malpractice claims against internists were analyzed. The rate of lawsuits being decided against internists was high (50.1%). The primary cause of litigation was diagnostic errors (213, 54%), followed by system errors (188, 45%). The foremost initial diagnostic error was "no abnormality" (17.2%) followed by ischemic heart disease (9.6%) and malignant neoplasm (8.1%). Following cause-adjustment for loss, system errors were 21.37 times more likely to lead to a loss. Losses were 6.26 times higher for diagnostic error cases, 2.49 times higher for errors occurring at night, and 3.44 times higher when "malignant neoplasm" was the first diagnosis. Conclusions This study found that system errors strongly contributed to internists' losses. Diagnostic errors, night shifts, and initial diagnoses of malignant neoplasms also significantly affected trial outcomes. Administrators must focus on both system errors and diagnostic errors to enhance the safety of patients and reduce internists' risk exposure.

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“…Diagnostic errors are a significant problem in outpatients [ 1 , 2 , 3 , 4 ]. Atypical patient presentations, the failure to consider other diagnoses, cognitive burden, and lack of time to think were reported to be the most commonly perceived factors contributing to diagnostic errors in an outpatient setting [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Artificial-Intelligence-Driven Differential-Diagnosis List on the Diagnostic Accuracy of Physicians: An Open-Label Randomized Controlled Study

Harada

Katsukura

Kawamura

et al. 2021

IJERPH

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Background: The efficacy of artificial intelligence (AI)-driven automated medical-history-taking systems with AI-driven differential-diagnosis lists on physicians’ diagnostic accuracy was shown. However, considering the negative effects of AI-driven differential-diagnosis lists such as omission (physicians reject a correct diagnosis suggested by AI) and commission (physicians accept an incorrect diagnosis suggested by AI) errors, the efficacy of AI-driven automated medical-history-taking systems without AI-driven differential-diagnosis lists on physicians’ diagnostic accuracy should be evaluated. Objective: The present study was conducted to evaluate the efficacy of AI-driven automated medical-history-taking systems with or without AI-driven differential-diagnosis lists on physicians’ diagnostic accuracy. Methods: This randomized controlled study was conducted in January 2021 and included 22 physicians working at a university hospital. Participants were required to read 16 clinical vignettes in which the AI-driven medical history of real patients generated up to three differential diagnoses per case. Participants were divided into two groups: with and without an AI-driven differential-diagnosis list. Results: There was no significant difference in diagnostic accuracy between the two groups (57.4% vs. 56.3%, respectively; p = 0.91). Vignettes that included a correct diagnosis in the AI-generated list showed the greatest positive effect on physicians’ diagnostic accuracy (adjusted odds ratio 7.68; 95% CI 4.68–12.58; p < 0.001). In the group with AI-driven differential-diagnosis lists, 15.9% of diagnoses were omission errors and 14.8% were commission errors. Conclusions: Physicians’ diagnostic accuracy using AI-driven automated medical history did not differ between the groups with and without AI-driven differential-diagnosis lists.

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Factors and impact of physicians’ diagnostic errors in malpractice claims in Japan

Cited by 33 publications

References 28 publications

Diagnostic Error Rates and Associated Factors for Lower Gastrointestinal Perforation: A Multicenter Retrospective Cross-sectional Study

Diagnostic Error Rates and Associated Factors for Lower Gastrointestinal Perforation: A Multicenter Retrospective Cross-sectional Study

Malpractice Claims of Internal Medicine Involving Diagnostic and System Errors in Japan

Efficacy of Artificial-Intelligence-Driven Differential-Diagnosis List on the Diagnostic Accuracy of Physicians: An Open-Label Randomized Controlled Study

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