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Time Constraints A Common Factor in Diagnostic Errors

A recent study on the causes of medical diagnostic errors has found several contributing factors, such as problems in patient encounters and time constraints.

Published in JAMA Internal Medicine, the study revealed that eight out of 10 misdiagnoses were due in part to errors during a physical exam or during medical-taking. One in five mistakes were related to referrals and sixteen percent of misdiagnoses involved patient-related errors, such as the patient failing to provide accurate medical histories or miscommunication.

Poor test result follow-up and tracking contributed to 15% of missed diagnoses, and 14% of the mistakes involved other testing mix-ups such as misinterpretations, or the mistaken belief that the result was not serious enough to warrant hospital admission.

The author of the study believes that the time crunch associated with office visits can play a role in medical errors, seeing as so many diagnostic mistakes involved the bread-and-butter of the office visit, such as how patients and physicians communicate and how doctors conduct exams and take histories.

Pneumonia, congestive heart failure, acute renal failure, cancer and urinary tract infection were the most commonly missed diagnoses.

For the study, the electronic records for 212,165 patients were examined, along with visits to 69 physicians and other health professionals during one year at a Veterans Affairs primary care facility and four other clinics that were part of a private, integrated health system.

Experts in the field said there are some steps physicians should take to reduce their risk of missing diagnoses because of a time crunch such as asking patients to fully communicate their problems and medical histories, and report when their conditions are not improving as expected. If more time is needed to get the right answer, doctors can ask patients to come in for a follow-up visit within a few days.

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Source: American Medical News: "Primary care time squeeze explains errors in diagnosis," March 11, 2013.


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