Missed and Erroneous Diagnoses Common in Primary Care Visits

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Fri Dec 6 19:42:23 UTC 2013


As a patient, and aware of how very long a diagnosis can take, I find it
nearly impossible to believe that the frequency of error is so low.  If I
saw two doctors a total of 12 times over six months, in addition to taking
5-6 invasive testing procedures before an actual cause for the problem was
found, how many diagnostic errors would be found?  One patient and
therefore one error, or the multiple of the visits by the doctors, which
could be calculated to be 12?


Without some guidelines to discuss this outside the medical establishment,
this issue will have little public support for its correction.  Rather, the
average patient, hearing about still another misdiagnosis or lengthy
failure to diagnose, will continue to lose faith in the medical system.
Especially with diffuse symptoms, many will wait until something is
obvious--and more dangerous--before being seen.
Peggy Zuckerman


On Thu, Dec 5, 2013 at 6:25 PM, Graber, Mark <Mark.Graber at va.gov> wrote:

> Rob - thanks for the opportunity to reflect on Hardeep's studies.
>  Although the focus of the paper was on how well 'trigger tools' worked in
> helping detect diagnostic errors, there were 3 findings from this and his
> related papers that in my view are really important:
>
> "First, no differential diagnosis was documented at the index visit in
> 81.1% of cases"   That's a remarkable finding.  It speaks to the problem of
> overconfidence and the too-common tendency we all have to satisfice on the
> first diagnosis that seems to explain all the facts at hand.  How many
> errors could be avoided if we just thought a little more broadly?
>  Completing even a modest differential diagnosis might accomplish that.
>
> "Most of the errors identified in our study involved missed diagnosis of a
> large variety of
> common conditions as opposed to either a few selected conditions or rare
> or unusual diseases."   This corroborates findings from Olga Kostopoulou
> and others:  Yes, we are likely to miss some rare diseases, but MOST of the
> diagnostic errors made involve common conditions.  In Hardeep's study these
> included pneumonia, heart failure, urinary tract infections, etc.  Common
> stuff.
>
> 3.  From Hardeep's data you can calculate an incidence of diagnostic error
> in ambulatory care:  "Singh et al found that roughly 0.1% of all primary
> care visits were associated with missed opportunities
> to make an earlier diagnosis and prevent "considerable harm."  This is
> from David Newman-Toker's editorial where he did the math on
> this.(Measuring diagnostic errors in primary care.  JAMA Intern Med 2013
> 173(6): 425-6.)  It sounds like we're doing a good job when you think of
> harm-related errors as being found only once in every 1000 visits, but when
> you consider that there a half BILIION such visits each year annually,
> that's a lot of harm.  So the answer to your question is: YES, PRIMARY CARE
> IS WHERE MOST OF THE ERRORS ARE MADE.  If my math is correct (assuming
> roughly 5000 hospitals in the US and 500 clinic visits every day), this is
> what the national and local stats look like.  Its a shocking set of
> statistics.
>
> Mark Graber, MD FACP
>
>
> [cid:3469123507_8095274]
>
>
>
> ________________________________
> From: robert bell <rmsbell at ESEDONA.NET>
> Reply-To: Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, robert bell <rmsbell at ESEDONA.NET>
> Date: Thu, 5 Dec 2013 16:29:10 -0500
> To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: [IMPROVEDX] Missed and Erroneous Diagnoses Common in Primary Care
> Visits
>
> FOR POSTING TO THE LIST
>
> This was published earlier in the year.
>
> http://archinte.jamanetwork.com/article.aspx?articleid=1656540
>
> Is it Primary Care where most diagnostic errors are made?!
>
> Rob Bell
>
>
>
>
>
>
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
> for Improving Diagnosis in Medicine
>
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>
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
> for Improving Diagnosis in Medicine
>
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-- 
Peggy Zuckerman
www.peggyRCC.wordpress.com







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