Can physicians/hospitals reduce diagnostic errors?

May 1, 2011

Experts are focused on how errors happen and how they can be reduced.

Because diagnoses that are delayed, wrong, or missed entirely account for 40,000 to 80,000 hospital deaths annually as well as 40% of medical liability lawsuits, experts are focusing on how errors happen and on finding ways to prevent them.

Diagnostic errors fall into 2 broad categories: cognitive errors and system errors. As an example of the former, Kaveh G. Shojania, MD, who has written studies reviewing autopsy examinations of diagnostic errors, noted that when an initial diagnosis is made-usually within minutes-the so-called anchoring bias can take hold: a cognitive mistake in which physicians hold on to an incorrect diagnosis and ignore new information that might lead to a different conclusion.

A 2005 study of diagnostic errors in internal medicine found that premature closure, the failure to continue considering reasonable alternatives after reaching an initial diagnosis, was the most common cognitive diagnostic error. Simple overconfidence in having reached the right conclusion is another cognitive mistake, resulting from incomplete information or reliance on intuition and hunches. Other possibilities are arriving at a diagnosis as being more likely if it readily comes to mind (availability bias); looking for evidence to support a diagnosis instead of looking for evidence that might rebut it (confirmation bias); and allowing a preliminary diagnostic label that has been given to a patient to gather steam so that other possibilities are wrongly excluded.

Solving systemic errors, the cause of about two-thirds of diagnostic errors according to the 2005 study, might be more straightforward. Errors caused by system problems include delayed tests and malfunctioning equipment, as well as communication problems such as failure to make necessary referrals or follow-up appointments or to report test results and diagnostic procedures in a timely manner. Experts hope that health information technology can help hospitals and physicians to overcome such communication failures. In the meantime, they advise physicians to forge true partnerships with their patients with clear lines of communication.

O'Reilly KB. Diagnostic errors: Why they happen. American Medical News Web site. December 6, 2010. http://www.ama-assn.org/amednews/2010/12/06/prsa1206.htm. Accessed April 16, 2010.

Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13):1493-1499.