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A unified conceptual model for diagnostic errors: underdiagnosis, overdiagnosis, and misdiagnosis
11Associate Professor, Department of Neurology, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital Meyer Building 8-154 600 North Wolfe Street, Baltimore, MD 21287, USA.
Abstract:
Progress in diagnostic error research has been hampered by a lack of unified terminology and definitions. This article proposes a novel framework for considering diagnostic errors, offering a unified conceptual model for underdiagnosis, overdiagnosis, and misdiagnosis. The model clarifies the critical separation between 'diagnostic process failures' (incorrect workups) and 'diagnosis label failures' (incorrect diagnoses). By dividing processes into those that are substandard, suboptimal, or optimal, important distinctions are drawn between 'preventable', 'reducible,' and 'unavoidable' diagnostic errors. The new model emphasizes the importance of mitigating diagnosis-related harms, regardless of whether the solutions require traditional safety strategies (preventable errors), more effective evidence dissemination (reducible errors; harms from overtesting and overdiagnosis), or new scientific discovery (currently unavoidable errors). Doing so maximizes our ability to prioritize solving various diagnosis-related problems from a societal value perspective. This model should serve as a foundation for developing consensus terminology and operationalized definitions for relevant diagnostic-error categories.
Insights
This study introduces a new framework to define diagnostic errors, including underdiagnosis, overdiagnosis, and misdiagnosis. It distinguishes between process and label failures, categorizing errors as preventable, reducible, or unavoidable to guide harm mitigation strategies.
Area of Science:
- Medical Informatics
- Health Services Research
- Patient Safety
Background:
- Diagnostic error research lacks unified terminology and definitions, hindering progress.
- Existing frameworks do not adequately distinguish between diagnostic process and outcome failures.
- Underdiagnosis, overdiagnosis, and misdiagnosis represent significant challenges in healthcare.
Purpose of the Study:
- To propose a novel, unified conceptual framework for understanding diagnostic errors.
- To differentiate between diagnostic process failures and diagnosis label failures.
- To categorize diagnostic errors as preventable, reducible, or unavoidable.
Main Methods:
- Development of a conceptual model for diagnostic errors.
- Classification of diagnostic processes as substandard, suboptimal, or optimal.
- Distinction between 'diagnostic process failures' and 'diagnosis label failures'.
Main Results:
- The proposed model clarifies the distinction between incorrect workups and incorrect diagnoses.
- Errors are categorized based on process quality (substandard, suboptimal, optimal).
- A clear separation is established between preventable, reducible, and unavoidable diagnostic errors.
Conclusions:
- The framework provides a unified conceptual model for diagnostic errors, including underdiagnosis, overdiagnosis, and misdiagnosis.
- It emphasizes mitigating diagnosis-related harms by addressing preventable, reducible, and unavoidable errors.
- This model serves as a foundation for developing consensus terminology and operationalized definitions in diagnostic error research.