Definition of Diagnosis Error

Grubenhoff, Joe Joe.Grubenhoff at CHILDRENSCOLORADO.ORG
Wed Jan 18 20:20:27 UTC 2017


If not, over-dx should be considered an error. The most common reason kids are prescribed antibiotics is for otitis media which most of them don’t have…maybe a pink drum but no true infection. Another is strep pharyngitis – swabs obtained in kids with URI sx, swabs obtained in kids with fever and abdominal pain but no throat pain, swabs obtained with negative Rapid strep tests that are ignored, all in a population where there is an ~25% carrier state. Then you have all the PE tubes and tonsillectomies done because of over-diagnosis…less is more sometimes.

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Joe Grubenhoff, MD, MSCS| Associate Professor of Pediatrics
Section of Emergency Medicine | University of Colorado
Associate Medical Director - Clinical Effectiveness
Children's Hospital Colorado
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From: Bob Latino [mailto:blatino at RELIABILITY.COM]
Sent: Wednesday, January 18, 2017 6:55 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Definition of Diagnosis Error

Is over-diagnosis considered a diagnostic error?

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From: Bob Latino [mailto:blatino at RELIABILITY.COM]
Sent: Wednesday, January 18, 2017 6:23 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Definition of Diagnosis Error

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.


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