Eta S. Berner, EdD; Randolph A. Miller, MD; Mark L. Graber, MD
Potential Financial Conflicts of Interest: None disclosed.
Berner E., Miller R., Graber M.; Missed and Delayed Diagnoses in the Ambulatory Setting. Ann Intern Med. 2007;146:470. doi: 10.7326/0003-4819-146-6-200703200-00022
Download citation file:
Published: Ann Intern Med. 2007;146(6):470.
TO THE EDITOR:
We applaud Gandhi and colleagues (1) for highlighting the problem of outpatient diagnostic errors. However, malpractice claims are a biased data source. Primary identification of diagnostic errors in ambulatory settings remains problematic.
Wachter (2) highlighted differences that make diagnostic error detection more difficult in ambulatory settings than in hospitals. Outpatient diagnosticians typically record their observations and conclusions incompletely and illegibly on paper charts, which contributes to the lack of knowledge about the extent of diagnostic errors. Paper-based outpatient records are expensive to collect and analyze for outcome studies. In outpatient settings, fewer diagnostic gold standard procedures occur and irregular follow-up facilitates missing sentinel events. Incorrect outpatient diagnoses may go unnoticed for self-limited disorders. For more serious conditions, patients may present to serial physicians for second opinions; earlier physicians in the chain may never learn of a definitive diagnosis made elsewhere. As a result, available estimates of rates of outpatient diagnostic errors may represent lower bounds for their true frequency. Malpractice claims make up an even smaller proportion of the total.
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only