Report Analyzes Sources of Diagnostic Errors

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A new report conducted by the Risk Management Foundation of the Harvard Medical Institutions has analyzed medical data concerning the medical malpractice risk factors concerning diagnostic errors and found that the majority of these errors involve lapses in clinical judgment, patient compliance, and a failure in communication. The study found that “Researchers further divided the subset of diagnostic-related cases—slightly over 4700—into three categories: emergency department (ED) care, inpatient care, and ambulatory care. They found that most of the diagnostic failures—57% (2685 cases)—occurred in ambulatory care, where the top three missed diagnoses involved cancer, heart disease, and orthopedic injuries. Inpatient care was next on the list of problematic areas with 26% (1223 cases), followed by ED care with 16% (752 cases). Given their position in the front line of patient care, it should come as no surprise that family physicians and internal medicine doctors (along with other doctors of medicine, including gastroenterologists) accounted for 49% of the diagnostic failures in ambulatory care. Surgeons and radiologists were involved in 17% and 15%, respectively.

Pathologists and a broad group of “other” physicians were involved in the remaining 19% of cases. The study traced nearly three quarters of the diagnostic failures in ambulatory care to lapses in clinical judgment, followed by patient compliance (25%) and communication breakdowns (24%). (Most cases included more than one factor.) The top three lapses in clinical judgment were delay in or failure to order a diagnostic test (31%), misinterpretation of a diagnostic test (23%), and failure to establish a differential diagnosis (22%).” This data should be used to address and fix the problems associated with diagnostic errors in all clinical settings.

Mark Abramson
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