Almost 80% of diagnostic errors identified in a small study of primary care physicians were the result of process breakdowns in the patient-practitioner clinical encounter, according to data published online in late February in JAMA: Internal Medicine.
Many of the diagnoses missed were for conditions commonly seen in primary care that also carry the potential for “moderate to severe harm.”
Breakdowns during the clinical encounter most commonly occurred
• during history taking (56.3%) and physical examination (47.4%)
• when ordering further diagnostic tests (57.4%), and
• as a result of failure to review previous documentation (15.3%).
Process breakdowns were also seen in the referral process (19.5%); follow-up and tracking of diagnostic information (14.7%); and performance and interpretation of diagnostic tests (13.7%).
The study identified 190 unique diagnostic errors, defined as missed, delayed, or wrong diagnoses at a large Veterans Affairs facility and a large private health care system. Of the 190 cases, 68 unique diagnoses were missed, including pneumonia (6.7%), decompensated congestive heart failure (5.7%), acute renal failure (5.3%), cancer (5.3%), and urinary tract infection (4.8%).
The abstract of the study is available here.
The full text of the invited commentary can be viewed here.
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Breakdowns in Process Are Key to Missed Diagnoses in Primary Care
March 14, 2013
by ERASTOTHENES DE ALEJANDRIA | March 19, 2013 1:18 PM EDT Actually the percentage exceeds 30% and that gives evidence that the formation of primary physicians is not good, and that time as well as to study the sick is short. These failures always produce an excess of work in hospitals and clinics especialiadas with significant spending increase. So it is necessary to intensify the pathophysiological formation, first Physiology, because if you don't know the normal function of the organism, his illness is not known. After pharmacological training to know how to use drugs and finally the teaching of practice in the application of the above. This is the only way to improve these statistics |
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