title: Diagnostic error in medicine: analysis of 583 physician-reported errors.
abstract: 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.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St, Third Floor, Boston, MA 02120, USA. gschiff@partners.org
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Schiff
authors.forename: Omar
authors.initials: O
authors.lastname: Hasan
authors.forename: Seijeoung
authors.initials: S
authors.lastname: Kim
authors.forename: Richard
authors.initials: R
authors.lastname: Abrams
authors.forename: Karen
authors.initials: K
authors.lastname: Cosby
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Lambert
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Elstein
authors.forename: Scott
authors.initials: S
authors.lastname: Hasler
authors.forename: Martin L
authors.initials: ML
authors.lastname: Kabongo
authors.forename: Nela
authors.initials: N
authors.lastname: Krosnjar
authors.forename: Richard
authors.initials: R
authors.lastname: Odwazny
authors.forename: Mary F
authors.initials: MF
authors.lastname: Wisniewski
authors.forename: Robert A
authors.initials: RA
authors.lastname: McNutt
mesh_terms: 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