The Big Three diagnostic errors through reflections of Japanese internists

Area of Science:

• Medical Diagnostics
• Internal Medicine
• Healthcare Quality Improvement

Background:

• Diagnostic errors are a significant concern in internal medicine.
• The 'Big Three' diagnostic error categories include malignant neoplasms, cardiovascular diseases, and infectious diseases.
• Understanding internists' perspectives on memorable diagnostic errors is crucial for improving patient safety.

Purpose of the Study:

• To analyze diagnostic errors in malignant neoplasms, cardiovascular diseases, and infectious diseases.
• To investigate internists' self-reported experiences with diagnostic errors.
• To identify factors contributing to diagnostic errors in these key disease categories.

Main Methods:

• Secondary analysis of a web-based cross-sectional survey of internists.
• Participants recalled their most memorable diagnostic error cases.
• Data collected included demographics, error recognition time, error location, and contributing factors (environmental, information processing, cognitive bias) rated on a Likert scale.

Main Results:

• The 'Big Three' comprised 54.1% of 687 reviewed diagnostic error cases.
• Malignancy errors often involved delayed diagnoses (46%), occurring in outpatient settings over months.
• Cardiovascular errors were linked to environmental factors, identified within days in emergency departments during night shifts/holidays.
• Infectious disease errors were significantly impacted by information gathering and interpretation.

Conclusions:

• The 'Big Three' diagnostic error categories represent a substantial portion of internists' recalled cases.
• Distinct contributing factors necessitate tailored strategies for each disease category.
• Addressing diagnostic errors requires disease-specific approaches for effective intervention.