Ross Koppel rkoppel at SAS.UPENN.EDU
Wed Apr 23 18:32:17 UTC 2014

First, I want to second Mark's comment.  It very much depends on the 
methodology used.  Hardeep's methodology (as all methods) is limited to 
the parameters he used (charts, return visits, etc).  While fine 
research (he's one of my heroes), it cannot be representative of the 
larger error rate, which would have to reflect the conditions that were 
unknown and did not appear in charts or in subsequent revisits or 
re-admits. I don't know what that ratio is, but it's non-trivial.  Very 
non-trivial.  Then, of course, as has been argued here, there's the 
definition of Dx error.  If it's delayed to the point that something 
could have been done but was not, that's different than if it took a few 
years but made no difference.


Ross Koppel, Ph.D. FACMI
Sociology Dept and Sch. of Medicine
Senior Fellow, LDI, Wharton
University of Pennsylvania, Phila, PA 19104-6299
215 576 8221 C: 215 518 0134

On 4/23/2014 1:32 PM, Graber, Mark wrote:
> Stephen,
> We (I) believe the risk of diagnostic error in general medical settings in the US is in the range of 10 - 15%  (Graber.  The Incidence of Diagnostic Error in Medicine;  BMJ Qual Saf 2013;22:ii21-ii27. doi:10.1136/bmjqs-2012-001615).  That's all errors, most of which (thankfully) are inconsequential or caught.  The risk of harm is clearly much less and its hard to put a number on that.
> The news stories centered on Hardeep's recent article  ( The frequency of diagnostic errors in outpatient care: estimations from three large observational studies
> involving US adult populations.  Singh H, et al. BMJ Qual Saf 2014;0:1-5. doi:10.1136/bmjqs-2013-002627) where they identified a risk of approximately 5% from chart reviews in primary care clinics.  That number is in the 10-15% ballpark, given that the approach would have missed errors that weren't obvious from the medical record, and errors for which the consequences played out elsewhere, and other methodologic issues.
> All of these numbers are based on research approaches.  So far, there aren't any healthcare organizations I know of that are measuring error rates in real time, and the challenges of actually doing this are substantial.  We have little data on the error rate for surgical patients, or patients seen in the ER.  There is a great need for research on this question, and for finding reliable and reproducible ways to find and count these errors going forward.  You can't improve what you can't measure.
> Mark
> Mark L Graber, MD FACP
> Senior Fellow, RTI International
> Professor Emeritus, SUNY Stony Brook School of Medicine
> Founder and President, Society to Improve Diagnosis in Medicine
> Phone:   919 990-8497

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