Don't Blame Hospitals for All Diagnostic Errors

Interestingly, the top missed diagnoses at one healthcare system studied were not the same as the top missed diagnoses at the other, and very few errors involved rare or unusual diseases.

The missed diagnoses often involved serious illnesses, from acute renal failure, pneumonia and cancer, to angina, cellulitis, hypertension, and urinary tract infections.

"Pneumonia and decompensated congestive heart failure were most commonly missed, although they accounted for less than 13% of all errors," the researchers wrote.

Singh says that once healthcare systems start measuring diagnostic errors in the primary care setting, many problematic practices will be revealed and process errors eliminated. "Because now, there's not a lot of measurement in this area, just the fact that if you start measuring, people will start to notice. If you give feedback to the doctors, saying, 'Hey, you know, in the last three months you had three patients who returned unexpectedly,' and maybe you will see some there were missed opportunities."

In an invited commentary, David E. Newman-Toker, MD, and Martin A. Makary, MD, of the departments of neurology and surgery, respectively, at Johns Hopkins University School of Medicine, said Singh and colleagues "are to be congratulated" for developing their trigger tool, "to help overcome shortfalls in traditional approaches to diagnostic error detection."