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Significant diseases often missed due to primary care diagnostic errors

A wide range of common diseases were often misdiagnosed by primary care physicians, according to new data.

Researchers examined 190 diagnostic errors recorded at two large health care systems from Oct. 1, 2006 to Sept. 30, 2007. Breakdowns in the “patient-practitioner clinical encounter” were responsible for 78.9% of misdiagnosed cases. The frequency of these breakdowns was:

• ordering diagnostic tests for further workup (57.4%)
• history-taking (56.3%)
• examination (47.4%)

Other factors that contributed to diagnostic errors were:

• referrals (19.5%)
• patient-related factors (16.3%)
• follow-up and tracking of diagnostic information (14.7%)
• performance and interpretation of diagnostic tests (13.7%)

“Most process breakdowns were related to the clinical encounter, wherein practitioners are almost always pressed for time to make decisions,” the investigators said.

Researchers concluded that most of the diagnostic errors had the potential for “moderate to severe” harm to patients.

The frequency of misdiagnosed conditions was:

• pneumonia (6.7%)
• decompensated congestive heart failure (5.7%)
• acute renal failure (5.3%)
• cancer (primary) (5.3%)
• urinary tract infection or pyelonephritis (4.8%)

“Most of the errors identified in our study involved missed diagnosis of a large variety of common conditions as opposed to either a few selected conditions or rare or unusual diseases,” the researchers wrote.

They concluded that preventive strategies should target common contributory factors, “especially those that involve data gathering and synthesis in the patient-practitioner encounter.”