The Big Three diagnostic errors through reflections of Japanese internists.

Autor:	Kunitomo K; Department of General Medicine, 37028 NHO Kumamoto Medical Center , Kumamoto, Japan., Gupta A; Medicine Service, 20034 Veterans Affairs Ann Arbor Healthcare System , Ann Arbor, MI, USA.; Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA., Harada T; Department of General Medicine, 83943 Nerima Hikarigaoka Hospital , Nerima-ku, Tokyo, Japan., Watari T; Medicine Service, 20034 Veterans Affairs Ann Arbor Healthcare System , Ann Arbor, MI, USA.; Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.; Department of General Medicine, 83943 Nerima Hikarigaoka Hospital , Nerima-ku, Tokyo, Japan.; General Medicine Center, Shimane University Hospital, Izumo shi, Shimane, Japan.
Jazyk:	angličtina
Zdroj:	Diagnosis (Berlin, Germany) [Diagnosis (Berl)] 2024 Mar 20; Vol. 11 (3), pp. 273-282. Date of Electronic Publication: 2024 Mar 20 (Print Publication: 2024).
DOI:	10.1515/dx-2023-0131
Abstrakt:	Objectives: To analyze the Big Three diagnostic errors (malignant neoplasms, cardiovascular diseases, and infectious diseases) through internists' self-reflection on their most memorable diagnostic errors. Methods: This secondary analysis study, based on a web-based cross-sectional survey, recruited participants from January 21 to 31, 2019. The participants were asked to recall the most memorable diagnostic error cases in which they were primarily involved. We gathered data on internists' demographics, time to error recognition, and error location. Factors causing diagnostic errors included environmental conditions, information processing, and cognitive bias. Participants scored the significance of each contributing factor on a Likert scale (0, unimportant; 10, extremely important). Results: The Big Three comprised 54.1 % (n=372) of the 687 cases reviewed. The median physician age was 51.5 years (interquartile range, 42-58 years); 65.6 % of physicians worked in hospital settings. Delayed diagnoses were the most common among malignancies (n=64, 46 %). Diagnostic errors related to malignancy were frequent in general outpatient settings on weekdays and in the mornings and were not identified for several months following the event. Environmental factors often contributed to cardiovascular disease-related errors, which were typically identified within days in emergency departments, during night shifts, and on holidays. Information gathering and interpretation significantly impacted infectious disease diagnoses. Conclusions: The Big Three accounted for the majority of cases recalled by Japanese internists. The most relevant contributing factors were different for each of the three categories. Addressing these errors may require a unique approach based on the disease associations. (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)
Databáze:	MEDLINE
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