title: The global burden of diagnostic errors in primary care.
abstract: Diagnosis is one of the most important tasks performed by primary care physicians. The World Health Organization (WHO) recently prioritized patient safety areas in primary care, and included diagnostic errors as a high-priority problem. In addition, a recent report from the Institute of Medicine in the USA,'Improving Diagnosis in Health Care', concluded that most people will likely experience a diagnostic error in their lifetime. In this narrative review, we discuss the global significance, burden and contributory factors related to diagnostic errors in primary care. We synthesize available literature to discuss the types of presenting symptoms and conditions most commonly affected. We then summarize interventions based on available data and suggest next steps to reduce the global burden of diagnostic errors. Research suggests that we are unlikely to find a 'magic bullet' and confirms the need for a multifaceted approach to understand and address the many systems and cognitive issues involved in diagnostic error. Because errors involve many common conditions and are prevalent across all countries, the WHO's leadership at a global level will be instrumental to address the problem. Based on our review, we recommend that the WHO consider bringing together primary care leaders, practicing frontline clinicians, safety experts, policymakers, the health IT community, medical education and accreditation organizations, researchers from multiple disciplines, patient advocates, and funding bodies among others, to address the many common challenges and opportunities to reduce diagnostic error. This could lead to prioritization of practice changes needed to improve primary care as well as setting research priorities for intervention development to reduce diagnostic error.
authors.affiliation: Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
authors.affiliation: General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Schiff
authors.affiliation: RTI International, Research Triangle Park, North Carolina, USA.|SUNY Stony Brook School of Medicine, Stony Brook, New York, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Graber
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
authors.forename: Igho
authors.initials: I
authors.lastname: Onakpoya
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thompson
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods; D003951:Diagnostic Errors / Q000191:economics*; D019937:Diagnostic Techniques and Procedures; D004501:Education, Medical / Q000458:organization & administration; D014943:Global Health; D006291:Health Policy; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D010358:Patient Participation / Q000379:methods; D061214:Patient Safety; D011320:Primary Health Care / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000458:organization & administration; D018570:Risk Assessment; D014944:World Health Organization
keywords: Diagnostic errors; Health policy; Information technology; Patient safety; Primary care