Definition of Diagnosis Error

Albert Wu awu at JHU.EDU
Sun Feb 5 20:44:19 UTC 2017


Michael
I wonder if what you are describing are not diagnostic errors, but treatment error of omission and commission

In my mind the diagnostic error precedes these
Albert

Albert W. Wu, MD
Johns Hopkins

From: "Kohn, Michael" <Michael.Kohn at UCSF.EDU>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Kohn, Michael" <Michael.Kohn at UCSF.EDU>
Date: Sunday, February 5, 2017 at 1:29 PM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Definition of Diagnosis Error

Dear Colleagues,

As per my prior post, I see two types of diagnostic error: 1) failing to provide effective treatment for something the patient has, and 2) treating unnecessarily for something the patient doesn't have.  If you believe tPA is effective treatment for acute stroke, then failing to provide it to a patient with a stroke is the first type of error, and providing it to a patient with a stroke mimic, such as a complicated migraine, is the second type of error.  Overdiagnosis is the second type of error.  Giving the wrong treatment combines (1) failing to treat with (2) treating unnecessarily.

One correspondent correctly pointed out that these are actually treatment errors.  I am focused on incorrect decisions, not incorrect naming of a patient's illness.  With my narrower view, failing to apply the correct name to a benign, self-limited condition is not an error so long as you don't provide unnecessary and harmful treatment.  Also, failing to distinguish between two illnesses with the same effective treatment is not an error unless you fail to provide that treatment.  I am not one of those physicians who tries to please patients by applying a Greek name to their benign problem (cephalgia for headache), but this isn't necessarily an error.  Failing to identify an aneurysmal subarachnoid hemorrhage is an error because prompt referral for coiling can save the patient's life.

One other point: all of this refers to patients who have symptoms, i.e., they feel sick.  Screening of patients with no known symptoms of disease is a different matter.  That is primarily though not exclusively what H. Gilbert Welch was referring to in "Overdiagnosed: Making People Sick in the Pursuit of Health".

Respectfully,

Michael

Michael A. Kohn, MD, MPP



Chairman, Emergency Department

Mills-Peninsula Medical Center



Associate Professor

UCSF Epidemiology and Biostatistics

(Email created using voice recognition.  Please excuse transcription errors.)

________________________________
From: Joe Graedon [jgraedon at GMAIL.COM]
Sent: Sunday, February 05, 2017 5:32 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Definition of Diagnosis Error
Bob,

I think the IOM definition is comprehensive and helpful.

Joe

Sent from my iPad

On Jan 18, 2017, at 8:54 AM, Bob Latino <blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM>> wrote:
Is over-diagnosis considered a diagnostic error?

Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645
blatino at reliability.com<mailto:blatino at reliability.com>
www.reliability.com<http://www.reliability.com>
<image001.jpg><https://www.linkedin.com/company/958495?trk=tyah&trkInfo=clickedVertical%3Acompany%2CclickedEntityId%3A958495%2Cidx%3A1-1-1%2CtarId%3A1464096807851%2Ctas%3Areliability%20center%2C%20inc.>

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.


Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645
blatino at reliability.com<mailto:blatino at reliability.com>
www.reliability.com<http://www.reliability.com>
<image001.jpg><https://www.linkedin.com/company/958495?trk=tyah&trkInfo=clickedVertical%3Acompany%2CclickedEntityId%3A958495%2Cidx%3A1-1-1%2CtarId%3A1464096807851%2Ctas%3Areliability%20center%2C%20inc.>

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