title: Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.
abstract: BACKGROUND
  Because of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area.
  
  
  OBJECTIVE
  To ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these.
  
  
  METHODS
  Secondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK.
  
  
  METHODS
  Two datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically.
  
  
  RESULTS
  Learning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed.
  
  
  CONCLUSIONS
  Learning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Clare R
authors.initials: CR
authors.lastname: Goyder
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Caroline H D
authors.initials: CH
authors.lastname: Jones
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Heneghan
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, WA, US.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thompson
mesh_terms: D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D058006:General Practice / Q000592:standards; D006801:Humans; D007858:Learning; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012017:Referral and Consultation / Q000592:standards*; D006113:United Kingdom / Q000453:epidemiology
keywords: clinical reasoning; decision making; diagnosis; diagnostic errors; education; general practice