The patient experience of diagnostic error

E. Scott Geller esgeller at VT.EDU
Mon Oct 21 17:50:57 UTC 2013

Dear Concerned Professionals,

I have been following your thoughtful emails for quite a while and have been very impressed with your diligence and caring.  This issue about misdiagnosis inspired me to write a brief response.  I was misdiagnosed 12 years ago for BPH instead of Prostate Cancer.  I was put on Proscar for the misdiagnosis for BPH, and therefore follow-up PSA tests were not  reliable.  Two years later I decided to come off of Proscar, and then my PSA indicated a biopsy was called for.  I had prostate cancer, I had surgery, and radiation, and I still have prostate cancer, indicated by a slow rising PSA.  I experienced several medical errors throughout 12 years of this ordeal, from the misdiagnosis to a surgery error and then a release from the hospital before I was ready.  

All of this led to me teaming up with the editor of Industrial Safety and Hygiene News to write a book entitled: People-Based Patient Safety: Enriching your culture to prevent medical error.  The book was published by Coastal Training Technologies Corporation in 2007, but was never marketed.  Thus, this useful book that brings the psychology of safety to the medical field did not reach the audiences it deserves to reach.  Your discussions on medical error and misdiagnosis, as well as concerns for the patients' perspective suggests the value of this book.  If anybody out there is interested in seeing this book please email me directly or safety at (   We even produced DVDs and workbooks to explain the human dynamics of patient safety and medical error, but again Coastal was not successful at marketing these products.  I am disappointed in this, not for the loss of revenue, but for the useful information from psychology that the medical profession has missed.  

Thanks for reading this email, and more importantly for the thoughtful and actively-caring emails I have read on your listserve.



E. Scott Geller, Ph.D.
Alumni Distinguished Professor
Center for Applied Behavior Systems
213 Williams Hall
Virginia Tech
Blacksburg, VA 24061-0436

-----Original Message-----
From: Alexander, Jack W. [mailto:Alexander.Jack at MAYO.EDU] 
Sent: Monday, October 21, 2013 9:12 AM
Subject: Re: [IMPROVEDX] The patient experience of diagnostic error

Thanks Tim. Interesting thoughts and potentially very rich area for research. Two areas come to mind as I think through your email.
First, it would be interesting to understand patients' perceptions and actions who feel they have been misdiagnosed, even if they haven't. I imagine this leads to excess testing, expense and ultimately patient harm that may be averted by effective communication about the diagnostic process.

Second, it would be interesting to understand how patients' "self-diagnosis" results in bias that actually leads to misdiagnosis. I assume this will become a bigger and bigger issue as online diagnostic aids become available. 

Good luck with your work.


Jack W Alexander M.D. | Internal Medicine | Phone: 651-267-5058 | Pager: 651-267-4053 |E-mail: alexander.jack at Chief Medical Officer Mayo Clinic Health System-Red Wing | 701 Fairview Blvd, PO Box 95 | Red Wing, MN 55066-0095  Please don't print this e-mail unless you really need to. Thank you. 

-----Original Message-----
From: owner-improvedx at [mailto:owner-improvedx at] On Behalf Of Siggs, Tim
Sent: Saturday, October 19, 2013 7:02 AM
Subject: [IMPROVEDX] The patient experience of diagnostic error

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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