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Health See other Health Articles Title: Missed and Erroneous Diagnoses Common in Primary Care Visits Medscape: A large variety of common diseases are missed in the primary according to a new study, almost 80% of these errors stem from breakdowns in the patient–practitioner clinical encounter. Most errors also have the potential to cause moderate to severe harm. Hardeep Singh, MD, MPH, from Baylor College of Medicine in Houston, Texas, and colleagues published their medical record review online February 25 in JAMA Internal Medicine. The authors analyzed 190 primary care diagnostic errors that occurred from October 1, 2006, to September 30, 2007 in a large urban Veterans Affairs facility that was part of an integrated healthcare system. Dr. Singh and colleagues developed automated "trigger tools" specifically to aid in the detection of diagnostic errors from electronic health records. The researchers acknowledge that although these trigger tools represent a significant improvement over traditional approaches of detecting diagnostic error, their study likely underestimates the full burden. The most commonly missed diagnoses were pneumonia (6.7%), decompensated congestive heart failure (5.7%), acute renal failure (5.3%), and primary cancer (5.3%). Cough was the most common chief presenting symptom associated with a missed diagnosis. The authors identified several process breakdowns that contributed to missed diagnoses. Process breakdowns involved the patient–practitioner clinical encounter (78.9%) or stemmed from referrals (19.5%), patient-related factors (16.3%), follow-up and tracking diagnostic information (14.7%), and performance and interpretation of diagnostic tests (13.7%). About half the time (43.7%), more than a single process breakdown contributed to the missed diagnosis. In interpreting their data, the authors propose that as physicians increasingly rely on technology and team-based care there may be a drop in basic clinical skills and related cognitive processes. Shortened office visits may also exacerbate this problem. The authors go on to discuss possible solutions, acknowledging that any solution will have to recognize that medical diagnosis is difficult, messy, and imperfect. They suggest that a focus on taking medical histories, performing physical examinations, and ordering tests may help reduce diagnostic error. In addition, it may be helpful to encourage physicians to document a differential diagnosis at the initial visit. "Diagnostic errors are associated with substantial harm at individual patient and public health levels, and their burden may be much greater than previously appreciated," David E. Newman-Toker, MD, PhD, and Martin A. Makary, MD, MPH, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, write in an accompanying invited commentary. "Trigger tools offer a promising means to measure the problem and explore the impact of error-reduction interventions. If we are to accomplish this goal, stakeholders, including health care systems, accrediting bodies, risk insurers, payers, providers, patients, and especially research funding agencies, must make improved diagnostic safety and quality a top priority." In the commentary, Dr. Newman-Toker and Dr. Makary make several suggestions, including that electronic health records systems include mandatory recording and coding not only of diagnoses but also of presenting symptoms. The study was supported by a National Institutes of Health K23 Career Development Award to Dr. Singh, by an Agency for Health Care Research and Quality Health Services Research Demonstration and Dissemination to a coauthor, and a Houston VA HSR&D Center of Excellence grant and the VA Office of Academic Affiliations Fellowship Program to another coauthor. The authors and editorialists have disclosed no other relevant financial relationships. JAMA Intern Med. Published online February 25, 2013. Article full text, Commentary full text Post Comment Private Reply Ignore Thread Top • Page Up • Full Thread • Page Down • Bottom/Latest
#1. To: Tatarewicz (#0)
Oh right. But of course, coding and electronic records "will impact error-reduction interventions." I'd add that we need to replace physicians with LPN's and nurse practitioners and translators and Obamacare will be so cost efficient and perfect and error free. Kiss **s academic medical dolts wanting more Obamacare grants to study stuff.
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