The patient experience of diagnostic error

Leonard Berlin lberlin at LIVE.COM
Sun Oct 20 23:32:09 UTC 2013

In his book a few years ago, Jerome Groopman called this "diagnosis momentum."  In radiology we call it the "alliterative error." Once a diagnosis is in play, it is very difficult to convince the physician to consider an alternative diagnosis.
Len Berlin
Date: Sun, 20 Oct 2013 15:02:37 -0400
From: lee.tilson at GMAIL.COM
Subject: Re: [IMPROVEDX] The patient experience of diagnostic error

I used to be a philosopher / logician. 
My biggest question is "How are doctors intellectually seduced into error?"
There are many answers, perhaps a different one for each different episode of misdiagnosis. 

In my case, I am aware of two misdiagnoses involving my family that have the following logical structure. 
There were several symptoms / abnormal findings to be explained by a correct diagnosis. Both of my family's misdiagnoses were cases in which the treaters had explanations (diagnoses) of the symptoms / abnormals, but the explanations (diagnoses) the treaters made were not nearly the best explanations of the symptoms / abnormals. 

My son had three abnormal symptoms / findings after being admitted for meningitis: 
     abnormal brain scan with cerebellar tonsils in the top of the spinal canal

     abnormal respirations - Cheyne Stokes respirations
     abnormal heart rhythm. 
The first item listed on the informed consent sheet was "cerebral edema"

Cerebral edema explained all of his abnormal findings. 
The treaters insisted that the cerebellar tonsils were a sign of Arnold Chiari malformation of the brain, something my son never had. 

I could not get the treaters to consider the "cerebral edema" explanation of the abnormals even though it was a better explanation for several reasons, and it was also the most dangerous.  It was better because 1.  it was a simpler explanation - one explanation covered all of these abnormal symptoms / findings, 2. it did not require any new assumptions about extremely rare underlying, undiagnosed congenital anomalies, 3. edema fit perfectly in the context of the disease that had been diagnosed. 

Objectively, edema was just a better explanation. 
However, once someone considered "Arnold Chiari malformation," it was impossible to get them to consider alternate explanations. 

Subsequent studies proved there was no Arnold Chiari malformation. 

I realize that my analysis is unusual. We all bring different things to the table. I brought my background in logic and philosophy. 

Let me know if you find this helpful

On Sat, Oct 19, 2013 at 8:01 AM, Siggs, Tim <ts228 at> wrote:

Good afternoon all,

I am a Clinical Psychology trainee at the University of Leicester, UK, with an interest in Diagnostic Error and am conducting research into this area for my doctoral thesis. As a clinical psychologist to be,I am particularly interested in the patient experience of diagnostic error with a view to understand the implications of either experiencing, or perceiving the experience of, a diagnostic error with reference to future health behaviours in patients with chronic illnesses e.g. self management of a chronic condition, adjustment, treatment adherence etc. I have followed this listserv for a number of months and have found it to be an interesting and insightful source of topical information, thank you all.

I am writing today to ask for thoughts and suggestions regarding my research both generally and for a specific question. Firstly there appears to be a lack of published studies exploring the depth of experiencing diagnostic error from a patient perspective, there are several studies looking at adverse events as a whole which include diagnostic error within them (e.g. Elder et al., 2005; Entwistle et al., 2010; Kistler et al., 2010; Kuzel et al., 2004; Mazor et al., 2012; Molassiotis et al., 2009; Ocloo, 2010), but do not offer specification of the diagnostic error experience in itself, and I believe that the impact may be very different for diagnostic error. I feel that illuminating this perspective may help to address the psychological and emotional impact of diagnostic error such as that which can present in a medical psychology department, and this knowledge may also inform ideas regarding the process of diagnostic error from the patient's perspective. So my question to ask is does anyone know of any studies, particularly qualitative, that examine the patient experience of diagnostic error or have any particular thoughts on this topic area? In particular I'm interested to know if there are any identified (evidence based?) approaches to supporting patients who have experienced diagnostic error anyone is aware of?

Having searched much of the literature I am cognizant of the moves to bring the patient into the patient safety process and also diagnostic error and hope that my proposed research can add to this. Any thoughts or ideas you may have are welcomed.

Many Thanks


Tim Siggs

Trainee Clinical Psychologist

University of Leicester

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