We surveyed pediatricians to elicit their perceptions regarding frequency, contributing factors, and potential system- and provider-based solutions to address diagnostic errors.
Academic, community, and trainee pediatricians (N = 1362) at 3 tertiary care institutions and 109 affiliated clinics were invited to complete the survey anonymously through an Internet survey administration service between November 2008 and May 2009.
The overall response rate was 53% (N = 726). More than one-half (54%) of respondents reported that they made a diagnostic error at least once or twice per month; this frequency was markedly higher (77%) among trainees. Almost one-half (45%) of respondents reported diagnostic errors that harmed patients at least once or twice per year. Failure to gather information through history, physical examination, or chart review was the most-commonly reported process breakdown, whereas inadequate care coordination and teamwork was the most-commonly reported system factor. Viral illnesses being diagnosed as bacterial illnesses was the most-commonly reported diagnostic error, followed by misdiagnosis of medication side effects, psychiatric disorders, and appendicitis. Physicians ranked access to electronic health records and close follow-up of patients as strategies most likely to be effective in preventing diagnostic errors.
Pediatricians reported making diagnostic errors relatively frequently, and patient harm from these errors was not uncommon.
I was appalled by the article in the July issue "Errors of Diagnosis in Pediatric Practice". The article purports to survey "pediatricians" yet 1/3 of the sample group were trainees and not pediatric specialists (yet). Another 1/3 were academic physicians, a good percentage of whom did not routinely provide outpatient care.
Yet despite this, the article uses value laden terms such as "Pediatricians reported making diagnostic errors frequently" and "patient harm was not uncommon". What is the definition of "frequently"? What is the definition of "patient harm"?
In this day and age where trust in primary care physicians is eroded from exaggerated reporting in the media, I was shocked to see fodder for this type of attack coming from a journal as respected as Pediatrics. I have no problem in looking into personal and system issues that can lead to improved care, but the language used in this article is loose and pejorative.
As a practicing pediatrician whose patients' trust I work to continually earn, this article is insulting.
Conflict of Interest:
None declared