Family Practice, Vol 15, 308-318, Copyright © 1998 by World Organization of Family Doctors
A Bhasale
BACKGROUND: Although recognized by both patients and practitioners as a
highly undesirable outcome, little is known about the factors which
contribute to wrong diagnoses. Data collected through a pilot study of
incident monitoring in general practice in Australia were examined to
identify possible types of diagnostic incidents and their likely causes.
OBJECTIVES: The aim was to identify how diagnostic incidents occur and to
illuminate preventable and especially system causes of such incidents.
METHODS: GP participants anonymously reported any event of potential harm
to their patients, using both free text and structured-response categories.
Free text was analysed qualitatively for common themes, while fixed format
responses were used to provide an overall description of the data. RESULTS:
Diagnostic incidents occurred because of errors in judgement, particularly
in the formation and evaluation of diagnostic hypotheses. Other problems
related to systems of information transfer and medical records, and to poor
communication between patients and health providers and between health
professionals, which resulted in less than ideal care. CONCLUSION: Incident
monitoring is a useful tool for identifying sources of misdiagnosis and for
implementation and assessment of quality improvement strategies.
ORIGINAL CLINICAL RESEARCH
The wrong diagnosis: identifying causes of potentially adverse events in general practice using incident monitoring
Department of General Practice, University of Sidney, Australia.
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