Pulmonary Embolism, Drug Reactions Head List of Physician Diagnostic Errors

Researchers at Brigham and Women's Hospital (Boston, MA, USA) surveyed clinicians to solicit perceived cases of missed and delayed diagnoses. To do so, a six-item written survey was administered at 20 grand rounds presentations across the United States, and by mail at two collaborating institutions. Respondents were asked to report three cases of diagnostic errors and to describe their perceived causes, seriousness, and frequency. 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 researchers found that the most common missed or delayed diagnoses were PE (4.5%), drug reactions or overdose (4.5%), lung cancer (3.9%), colorectal cancer (3.3%), acute coronary syndrome (ACS, 3.1%), breast cancer (3.1%), and stroke (2.6%). Errors occurred most frequently in the testing phase, which included failure to order, report, and follow-up laboratory results (44%), followed by clinician assessment errors (32%), history taking (10%), physical examination (10%), and referral or consultation errors and delays (3%). The results of the survey were published in the November 9, 2009, issue of the Archives of Internal Medicine.

"This sample of diagnostic errors represents the largest reported case series of diagnostic errors to date and affords valuable insights into the types of errors that physicians are committing and witnessing,” concluded lead author Gordon Schiff, M.D., and colleagues of the division of general medicine and primary care. "One of the important insights to emerge from our review involves the overlapping and clustering of certain patterns of errors, patterns that may be useful to consider when designing error reduction and prevention strategies.”

The researchers noted that physicians readily offered information on diagnostic error, which suggests that diagnostic error is not unusual in clinical practice, and that actively soliciting such cases represents an opportunity for tapping into a hidden cache of medical errors that are not generally collected by existing error surveillance and reporting systems.

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