The relation of medical problem solving and therapeutic errors to disease categories

Review of 146 internal medicine cases at Emerson Hospital in Concord, Massachusetts, revealed significant variations in the patterns of physician error and medical problem solving for five diseases: recurrent congestive heart failure, transient ischemic attacks, recurrent cerebrovascular accidents, upper gastrointestinal hemorrhage, and acute bacterial pneumonia. Reviewers used general criteria to identify quality issues, which were separated into six error categories: insufficient data acquisition, inadequate hypothesis generation, inattention to or misinterpretation of cues, inappropriate or mismanaged therapy, delayed or missed diagnoses, and delayed treatment. The most common errors were inadequate hypothesis generation (38%) and inattention to or misinterpretation of cues (32%). Inappropriate or mismanaged therapy was found in 21% of cases.