Diagnostic errors in medicine: a case of neglect

Medical diagnoses that are wrong, missed, or delayed make up a large fraction of all medical errors and cause substantial suffering and injury. Compared with other types of medical error, however, diagnostic errors receive little attention-a major factor in perpetuating unacceptable rates of diagnostic error. Diagnostic errors are fundamentally obscure, health care organizations have not viewed them as a system problem, and physicians responsible for making medical decisions seldom perceive their own error rates as problematic. The safety of modem health care can be improved if these three issues are understood and addressed.

Opportunities to improve the visibility of diagnostic errors are evident. Diagnostic error needs to be included in the normal spectrum of quality assurance surveillance and review. The system properties that contribute to diagnostic errors need to be systematically identified and addressed, including issues related to reliable diagnostic testing processes. Even for cases entirely dependent on the skill of the clinician for accurate diagnosis, health care organizations could minimize errors by using system-level interventions to aid the clinician, such as second readings of key diagnostic tests and providing resources for clinical decision support. Physicians need to improve their calibration by getting feedback on the diagnoses they make. Finally, clinicians need to learn about overconfidence and other innate cognitive tendencies that detract from optimal reasoning and learning.

Clinicians and their health care organizations need to take active steps to discover, analyze, and prevent diagnostic errors.