Healthc Q. 2012 Apr;15 Suppl:50-6.
Perspectives on diagnostic failure and patient safety.
Source
MD, PhD, is a clinical consultant in patient safety, professor in Emergency Medicine, and director of the Critical Thinking Program in the Division of Medical Education at Dalhousie University in Halifax, Nova Scotia. He can be reached by e-mail at: croskerry@eastlink.ca.
Abstract
The Institute of Medicine (IOM) report To Err Is Human (Kohn et al. 1999), published at the turn of the century, signalled the beginning of the modern era of patient safety. Although a variety of good work followed, in hindsight what appears to have been missing at the beginning was sufficient pause to ask which of the many possible directions should be taken to achieve the most value for effort; only recently has this question been framed (Pronovost and Faden 2009). At the outset, it was understandable that the focus should be put on the tangible, obvious and most easily fixed problems. Medication error, for example, was quickly identified, and considerable work followed in this area. Other less tangible areas attracted less attention. Diagnostic failure appears to have been a major oversight and remains a major threat to patient safety. Wachter (2010) notes that the term medication error is mentioned more than 70 times in the IOM report (Leape et al. 1991), whereas diagnostic error appears only twice - even though physician errors that lead to adverse events are significantly more likely to be diagnostic (14%) than medication related (9%) (Leape et al. 1991). In both Canada (Canadian Medical Protective Association, personal communication, 2011) and the United States (Chandra 2005), diagnostic error is the leading cause of malpractice litigation. At the end of a long career in medical decision-making, Elstein (2009) estimated that diagnostic failure across the board in medicine was in the order of 15%.
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