Journal article
Diagnostic errors in primary care: lessons learned
Journal of the American Board of Family Medicine, Vol.25(1), pp.87-97
01/2012
DOI: 10.3122/jabfm.2012.01.110174
PMID: 22218629
Abstract
Diagnostic errors occur more commonly than other kinds of errors, they are more likely to harm patients, and they are more likely to be preventable. Little is known about the presenting complaints, initial (incorrect) diagnoses, and physicians' personal lessons learned related to diagnostic errors.
In 2009 and 2010, we invited a random sample of 200 family physicians, 200 general internists, and 200 general pediatricians practicing in Iowa to describe an important diagnostic error using a 1-page, mailed questionnaire. The data were analyzed using quantitative and qualitative methods.
The response rate was 34% (202 of 600 physicians). Common presenting complaints included abdominal pain (n = 27 of 202 patients, 13%); fever (n = 19; 9%); and fatigue (n = 15, 7%). Common initial (incorrect) diagnoses included benign viral infections (n = 35, 17%); musculoskeletal pain (n = 21, 10%); and chronic obstructive pulmonary disease/asthma (n = 13, 6%). The 202 responding physicians described 254 personal lessons learned, which we used to develop a taxonomy of 24 generic lessons. Three common lessons were: (1) consider diagnosis X in patients presenting with symptom Y (n = 37 lessons, 15%; eg, "Any discomfort above the umbilicus may be coronary artery disease."); (2) look beyond the initial, most obvious diagnosis (n = 26 lessons, 10%); and (3) be alert to atypical presentations of disease (n = 24 lessons, 9%).
In this study, diagnostic errors often were preceded by common symptoms and common, relatively benign initial diagnoses. The lessons learned often involved various aspects of broadening the differential diagnosis.
Details
- Title: Subtitle
- Diagnostic errors in primary care: lessons learned
- Creators
- John W Ely - Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242-1097, USA. john-ely@uiowa.eduLauris C KaldjianDonna M D'Alessandro
- Resource Type
- Journal article
- Publication Details
- Journal of the American Board of Family Medicine, Vol.25(1), pp.87-97
- DOI
- 10.3122/jabfm.2012.01.110174
- PMID
- 22218629
- ISSN
- 1557-2625
- eISSN
- 1558-7118
- Language
- English
- Date published
- 01/2012
- Academic Unit
- Stead Family Department of Pediatrics; Family and Community Medicine; General Internal Medicine; Internal Medicine; General Pediatrics and Adolescent Medicine
- Record Identifier
- 9984094356002771
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