Primary Care Most Common Place for Diagnostic Errors

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Most diagnostic errors occurred in the primary care setting and were for common conditions that could have the potential for moderate to severe harm, according to a new study.

In a new study of diagnostic errors most missed diagnoses were common conditions in primary care and most errors were associated with the potential for moderate to severe harm for patients.

The study, which appeared in JAMA Internal Medicine, analyzed 190 instances of diagnostic errors over the course of a year. The most commonly missed diagnoses were pneumonia, decompensated congestive heart failure, acute renal failure, cancer (primary), and urinary tract infection.

“Diagnostic errors identified in our study involved a large variety of common diseases and had significant potential for harm,” the authors wrote. “Most errors were related to process breakdowns in the patient-practitioner clinical encounter.”


While it might not be a surprise that the primary care setting — where physicians manage a wide range of conditions through brief encounters — is most vulnerable to medical errors, it’s still of increasing concern, the authors wrote.

Most errors were related to process breakdowns in the clinical encounter, usually because the practitioner was pressed for time to make decisions. The processes that led to errors were things like taking medical histories, performing physician examinations and ordering test.

“With the current emphasis on patient-centered medical homes that facilitate team-based care, patients might be able to access or interact with their practitioners more effectively,” the authors suggested. “However, these new models of care might not produce the level of cognitive support needed for gathering and/or interpreting a patient's key signs and symptoms effectively and safely.”

The authors stated that most errors were associated with the potential for moderate to severe harm was because the ones in the study were detected in the context of an unexpected hospitalization or return visit.

Since the study was focused at two large health systems, the methods may not apply to primary care practices that are not part of an integrated health care system.