diagnostic error (missed diagnosis)
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Etiology
- most commonly missed diagnoses:
- pneumonia (7%)
- congestive heart failure (6%)
- acute renal failure (5%)
- cancer (5%)
- urinary tract infection (5%)
- poor history-taking, physical exam, or failure to review the medical record account for ~80% of diagnostic errors
- patients with missed diagnoses tend to be older
- medical records associated with diagnostic errors tend to show no documentation of a differential diagnosis at the primary encounter
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
- availability heuristic
- 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
- what precipitated the current illness
- utilize clinical examination
- use pretest odds & post-test odds
- acknowledge the effect of the patient
- physicians may discount important data in patients with whom they have had difficult encounter
- physicians close to their patients tend to overestimate prognosis
- 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]
- facilitate better teamwork among healthcare workers, patients, & families
- find ways to identify & learn from diagnostic errors (systems approach)
- health IT that supports patients & healthcare workers through the diagnostic process
Notes
- majority of diagnostic errors involve several contributing factors
- interventions, including policy changes, should be multifaceted[7]
More general terms
Additional terms
References
- ↑ 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 - ↑ 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
- ↑ 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
- ↑ 4.0 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
- ↑ 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
- ↑ 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
- ↑ 7.0 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