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*停權中*
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這是一個國外關於誤診發生率的研究，或許醫生們要能夠先承認，誤診不是極少數的案例，我們的醫療才會進步。
但請民眾要有一個基本認知，就是不是醫師故意誤診，而是在現有的醫療科技下，必然存在一些盲點和不確定性。我們必須要有更透明的通報系統，來避免醫師作的誤診，重複在其他醫師診斷其他病人上面。
但是如果我們的醫師都死不認錯的一昧的隱瞞資訊，同樣一個小錯誤造成的誤診，或者延誤、錯誤治療，將造成無法統計的人命的損失。
引用:
Top List of Diagnostic Errors
November 11, 2009 — Pulmonary embolism and drug reactions or overdose are the most common diagnostic errors committed or observed by physicians, according to a survey of general practitioners and specialists, the results of which are published in the November 9 issue of the Archives of Internal Medicine.
This sample of diagnostic errors represents "the largest reported case series of diagnostic errors to date and affords valuable insights into the types of errors that physicians are committing and witnessing," write Gordon D. Schiff, MD, from the Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, and colleagues.
The goals of the study were to identify commonly missed diagnoses, to delineate recognizable patterns and themes, and to apply the new Diagnostic Error Evaluation and Research taxonomy tool for analyzing cases.
Researchers asked physicians to recall 3 clinically significant diagnostic errors that they had seen or committed, to estimate how often they had seen those errors, and to rate the clinical impact or outcome of each error. A diagnostic error was defined as any mistake or failure in the diagnostic process leading to a misdiagnosis, missed diagnosis, or delayed diagnosis.
Physicians readily offered information on diagnostic error. "This readiness suggests that diagnostic error is not unusual in clinical practice, and actively soliciting such cases represents an opportunity for tapping into a hidden cache of medical errors that are not generally collected by existing error surveillance and reporting systems," according to the authors.
The survey analyzed 583 cases of diagnostic error reported anonymously by 283 physicians — 47% were primary care physicians — from 22 institutions in 6 states. Physicians reported an average of 2.2 errors each. These physician respondents had been in practice an average of 9 years.
Of these 583 errors, 30% directly involved the reporting physician and 68% were witnessed by them. In all, 28% of these errors were rated as major in severity, 41% as moderate, and 31% as minor or insignificant.
Only 8% of the errors were considered common, with 35% rated as occasional, 26% as infrequent, and 27% as rare.
After pulmonary embolism (4.5% of total) and drug reactions or overdose, including poisoning (also 4.5%), the next most common missed diagnoses were lung cancer (3.9%), colorectal cancer (3.3%), acute coronary syndrome, including acute myocardial infarction and breast cancer (each 3.1%), and stroke (2.6%). At 20.2%, all types of cancer together constituted the largest disease category.
Errors in the testing phase, including failing to order, report, or follow-up on laboratory results, occurred most frequently (44%), followed by clinician assessment errors, such as failure to consider and overweighing competing diagnoses (32%), history taking (10%), physical examination (also 10%), and referral or consultation errors and delays (3%).
Inadequate follow-up of abnormal imaging studies emerged as a leading cause of diagnostic error. "Certainly, ensuring reliable follow-up of abnormal test results represents a "low-hanging fruit" ripe for improvement," write the authors.
They note that the testing and assessment categories overlapped. "One of the important insights to emerge from our review involves the overlapping and clustering of certain patterns of errors, patterns that may be useful to consider when designing error reduction and prevention strategies."
According to background information in the study, diagnostic errors are frequent; autopsy data show error rates of 10% to 15%. Such errors can result in patient injury and are the leading cause of medical malpractice litigation.
The authors have disclosed no relevant financial relationships.
Arch Intern Med. 2009;169:1881-1887. Abstract
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