Definition of Diagnosis Error

Mark Graber mark.graber at IMPROVEDIAGNOSIS.ORG
Wed Jan 18 17:54:42 UTC 2017


I've used the missed - wrong - delayed categories, which were originally created by the Australian Patient Safety Foundation decades ago.  These categories are useful in clarifying what things we're talking about in regard to diagnostic error.  The classification isn't perfect, because there will be overlap in the cases where a diagnosis is initially mis-labeled, but then correctly diagnosed later on (so originally wrong, but ultimately delayed).  Other limitations include the need to have some near-gold-standard way of knowing the correct diagnosis, and the fact that the categorization can only be done reliably in retrospect.

None of the other definitions are perfect either, but they are all useful, and highly complementary, depending on your goals.  For performance improvement research, the definitions that focus more on the DIAGNOSTIC PROCESS are especially useful:  Gordy Schiff's definition centers on identifying breakdowns in the process, and Hardeep Singh's definition centers on finding 'missed opportunities'.  

The IOM definition is the only patient-focused definition; it starts off as another 'label' failure, but then includes that key process step of communicating the diagnosis to the patient.  

A paper by David Newman-Toker is attached that provides more detail for anyone interested, and also attached are the attributions for these 4 definitions.

   Mark

Mark L Graber, MD FACP
President, Society to Improve Diagnosis in Medicine
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University


On Jan 18, 2017, at 8:17 AM, Tom Benzoni <benzonit at GMAIL.COM> wrote:

There are too many flaws in the definition to give it credibility.

Tom

On Jan 18, 2017 8:33 AM, "Bob Latino" <blatino at reliability.com <mailto:blatino at reliability.com>> wrote:
Is this IOM Definition of Diagnosis Error an accepted definition by SIDM?

 

What is Diagnostic Error?

The Institute of Medicine recently defined diagnostic error as the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient. Simply put, these are diagnoses that are missed altogether, wrong, or should have been made much earlier.

These categories overlap, but examples help illustrate some differences:

A missed diagnosis refers to a patient whose medical complaints are never explained. Many patients with chronic fatigue, or chronic pain fall into this category, as well as patients with more specific complaints that are never accurately diagnosed.

A wrong diagnosis occurs, for example, if a patient truly having a heart attack is told their pain is from acid indigestion. The original diagnosis is found to be incorrect because the true cause is discovered later.

A delayed diagnosis refers to a case where the diagnosis should have been made earlier. Delayed diagnosis of cancer is by far the leading entity in this category. A major problem in this regard is that there are very few good guidelines on making a timely diagnosis, and many illnesses aren’t suspected until symptoms persist, or worsen.

 

 

Robert J. Latino, CEO

Reliability Center, Inc.

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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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