Diagnostic error in medicine: analysis of 583 physician-reported errors.
BACKGROUND
Missed or delayed diagnoses are a common but understudied area in patient safety research. To better understand the types, causes, and prevention of such errors, we surveyed clinicians to solicit perceived cases of missed and delayed diagnoses.


METHODS
A 6-item written survey was administered at 20 grand rounds presentations across the United States and by mail at 2 collaborating institutions. Respondents were asked to report 3 cases of diagnostic errors and to describe their perceived causes, seriousness, and frequency.


RESULTS
A total of 669 cases were reported by 310 clinicians from 22 institutions. After cases without diagnostic errors or lacking sufficient details were excluded, 583 remained. Of these, 162 errors (28%) were rated as major, 241 (41%) as moderate, and 180 (31%) as minor or insignificant. The most common missed or delayed diagnoses were pulmonary embolism (26 cases [4.5% of total]), 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%]). Errors occurred 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 overweighing competing diagnosis) (32%), history taking (10%), physical examination (10%), and referral or consultation errors and delays (3%).


CONCLUSIONS
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.
Schiff
Gordon D
GD
Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St, Third Floor, Boston, MA 02120, USA. gschiff@partners.org
Hasan
Omar
O
Kim
Seijeoung
S
Abrams
Richard
R
Cosby
Karen
K
Lambert
Bruce L
BL
Elstein
Arthur S
AS
Hasler
Scott
S
Kabongo
Martin L
ML
Krosnjar
Nela
N
Odwazny
Richard
R
Wisniewski
Mary F
MF
McNutt
Robert A
RA
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003951:Diagnostic Errors / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007388:Internal Medicine / Q000592:standards* / Q000639:trends; D008297:Male; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011364:Professional Practice / Q000592:standards / Q000639:trends; D015203:Reproducibility of Results; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014481:United States