Clinical question: How can we categorize diagnostic pitfalls leading to diagnostic errors in primary care?
Background: Diagnostic errors are a leading cause of malpractice claims and are difficult to mitigate with system-level changes, as they are often multifactorial. The term “diagnostic pitfalls” to describe the circumstances leading to a diagnostic error is at least a century old but the authors offered a new definition of “clinical situations and scenarios that are vulnerable to errors that may lead to missed, delayed, or wrong diagnoses.”
Study design: Retrospective analysis of varied sources of diagnostic error reports in primary care settings
Setting: Ambulatory practices and academic medical centers in Massachusetts
Synopsis: 4,352 patient safety incident reports, 403 closed malpractice claims, 24 ambulatory morbidity and mortality rounds, and 355 responses from focus groups of six specialties who were asked about diagnostic errors and delays they had seen “upstream” in the course of the patient’s primary care. Using two taxonomies, the authors categorized the diagnostic errors and found that errors related to testing were the most commonly reported. Specific issues included failing to order appropriate testing, failing to follow up on abnormal test results, or misinterpreting test results. Awareness that diagnostic errors were most frequently related to issues regarding testing could lead to targeted interventions to decrease these errors.
A limitation of this review was that it was a convenience sample, and therefore is not a holistic representation of diagnostic errors.
Bottom line: Diagnostic errors reported in the primary care setting were most commonly related to issues of performing initial testing, interpreting test results, or following up on abnormal test results.
Citation: Schiff GD, et al. Characteristics of disease-specific and generic diagnostic pitfalls: a qualitative study. JAMA Netw Open. 2022;5(1):e2144531. doi:10.1001/jamanetworkopen.2021.44531.
Dr. Dreicer is an assistant professor of medicine at the University of Virginia School of Medicine, Charlottesville, Va.