Diagnostic errors in medicine

Diagnostic errors in medicine

The latest issue of the Archives of internal medicine[2009;169(20):1881-1887] published an interesting paper analyzing the diagnostic errors in medicine. Physicians from a few reputed hospitals in USA discovered that missed or delayed diagnoses are a common but understudied area in patient safety research. They surveyed clinicians to solicit perceived cases of missed and delayed diagnoses to better understand the types, causes, and prevention of such errors.

They administered a 6-item written survey at 20 grand rounds presentations across the United States and by mail at 2 collaborating institutions. They asked the respondents to report three cases of diagnostic errors and to describe their perceived causes, seriousness, and frequency.

Three hundred and ten physicians reported 669 cases from 22 institutions. They excluded cases without diagnostic errors or lacking sufficient details; Of the 583 cases that remained ,162 errors (28%) were rated as major, 241 (41%) as moderate, and 180 (31%) as minor or insignificant. Pulmonary embolism was the most common missed or delayed diagnoses(26 cases [4.5% of total]followed by drug reactions or overdose (26 cases [4.5%]), lung cancer (23 cases [3.9%]), colorectal cancer (19 cases [3.3%]), acute coronary syndrome (18 cases [3.1%]), breast cancer (18 cases [3.1%]), and stroke (15 cases [2.6%]).

Clinicians made errors most frequently in the testing phase (failure to order, report, and follow-up laboratory results) (44%), followed by clinician assessment errors (failure to consider and over-weighing competing diagnosis) (32%), history taking (10%), physical examination (10%), and referral or consultation errors and delays (3%).

The researchers concluded that physicians readily recalled multiple cases of diagnostic errors and were willing to share their experiences. Using a new taxonomy tool and aggregating cases by diagnosis and error type revealed patterns of diagnostic failures that suggested areas for improvement. Systematic solicitation and analysis of such errors can identify potential preventive strategies.


The authors were from Departments of Medicine (Drs Schiff and Kim and Mss Krosnjar and Wisniewski) and Emergency Medicine (Dr Cosby), Cook County Hospital, Chicago, Illinois; Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts (Drs Schiff and Hasan); Department of Medicine, Rush University, Chicago (Drs Schiff, Abrams, Hasler, and McNutt and Mr Odwazny); Departments of Health Policy and Administration (Dr Kim) and Medical Education (Dr Elstein) and College of Pharmacy (Dr Lambert), University of Illinois at Chicago; and Department of Family and Preventive Medicine, University of California, San Diego (Dr Kabongo).