How to Miss a Diagnosis in Primary Care

By Joe Elia

Diagnostic errors have a variety of contributing factors, but they most commonly occur during the encounter with the patient, according to a JAMA Internal Medicine study.

Researchers studied medical records from some 200 instances of unexpected return visits or emergency department use within 14 days of a primary care encounter — many due to missed diagnoses. The most commonly missed were pneumonia (7%), congestive heart failure (6%), and acute renal failure, cancer, and urinary tract infection (5% each). Faulty clinical encounters — involving, for example, bad history-taking, physical exam, or failure to review the existing record — were to blame in about 80% of cases.

Patients with missed diagnoses tended to be slightly older than those without errors. The medical records of the misdiagnosed tended to show no documentation of a differential diagnosis at the primary encounter. In addition, clinicians had often copied-and-pasted progress notes from the previous encounter into the electronic record.