diagnostic error (missed diagnosis)

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Etiology

Management

  • understand diagnostic heuristics[2]
    • availability heuristic
      • diagnosis based upon what is most easily available in the physician's mind (i.e. recent or memorable case ..)
    • anchoring (premature closure)
      • settling on a diagnosis early in the diagnostic process despite data that refute the diagnosis or support another
    • representativeness
      • application of pattern recognition (patient's presentation fits a typical case) thus it must be that case
  • utilize diagnostic time outs
    • taking time to periodically review a case without assuming the current diagnosis
  • plan for worse-case scenario
    • consider life-threatening diagnoses 1st
  • use systematic approach to common problems
  • ask the patient why he/she is sick
  • utilize clinical examination
  • use pretest odds & post-test odds
  • acknowledge the effect of the patient
  • look for clinical findings that do not fit the diagnosis
  • consider uncommon diagnoses
  • slow down & reflect
    • difficult to do with many physician's workloads
  • admit mistakes[2]
    • recognition of limitations may lead to improved quality of care
  • working in pairs may reduce diagnostic errors among medical students[3]
  • Institute of Medicine Recommendations[4]

Notes

  • majority of diagnostic errors involve several contributing factors
    • interventions, including policy changes, should be multifaceted[7]

More general terms

Additional terms

References

  1. Singh H et al Types and Origins of Diagnostic Errors in Primary Care Settings. JAMA Intern Med. 2013;():1-8 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23440149 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1656540
    Newman-Toker DE and Makary MA Measuring Diagnostic Errors in Primary Care. Comment on "Types and Origins of Diagnostic Errors in Primary Care Settings" JAMA Intern Med. 2013;():1-2 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23440273 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1656536
  2. 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
  3. 3.0 3.1 Hautz WE et al Diagnostic Performance by Medical Students Working Individually or in Teams. JAMA. 2015;313(3):303-304 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25603003 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2091295
  4. 4.0 4.1 Institute of Medicine Report. September 22, 2015 Improving Diagnosis in Health Care http://iom.nationalacademies.org/Reports/2015/Improving-Diagnosis-in-Healthcare.aspx
  5. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12915363
  6. Saber Tehrani AS, Lee H, Mathews SC et al 25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf. 2013 Aug;22(8):672-80. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23610443
  7. 7.0 7.1 Cheraghi-Sohi S, Holland F, Singh H et al Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices. BMJ Qual Saf. 2021;Epub Jun 14. https://psnet.ahrq.gov/issue/incidence-origins-and-avoidable-harm-missed-opportunities-diagnosis-longitudinal-patient