Parallel diagnostic universes: One patient.
Parallel diagnostic universes: One patient.
复制标题
并行诊断宇宙：一名患者。
DOI：
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发表时间：
2009
影响因子：
1.6
通讯作者：
C. Crock
中科院分区：
文献类型：
--
作者：
Dn Jones;C. Crock
诊断错误现在已经被牢牢地盯上了。它在所有医疗错误和法医学索赔中占显著且昂贵的比例，并可能对患者，亲属和医疗保健专业人员造成毁灭性后果。诊断错误的发生率相当高，在大多数医学领域高达15%，在“感知”专业中的发生率较低。然而，在一些已发表的医学成像工作中描述了大于15%的错误率和变化率，尽管并非所有错误都会导致患者伤害，并且还存在回顾性审查的问题。在医学成像解释中，误差和可变性之间也有区别，即并非所有的可变性都是由于误差造成的。澳大利亚医疗保健质量研究确定了2351例与住院相关的不良事件，其中20%代表诊断或治疗延迟，15.8%反映了未能“综合/决定/采取行动”信息。最近，诊断错误引起了患者安全组织的注意。2008年，美国卫生保健研究和质量机构（AHRQ）宣布，它打算支持旨在更好地了解发病率，成本，决定因素和预防或减轻诊断失败的策略的研究。医学上的决定往往是在不确定的条件下做出的。尽管诊断技术有了很大的进步，包括先进的成像技术，但医生还是会误诊病人。已经提出了复杂的模型来对这些错误进行分类。然而，大多数医生和实习生对诊断错误的认知和基于系统的基础了解有限。此外，他们往往不知道可以防止这些错误的技术。直到最近，诊断错误一直没有得到仔细的审查和研究，因为它不容易理解或衡量，也很难识别，有时会在很长一段时间内显现出来。它往往被视为个别从业人员的失败，而不是一个组织或系统性问题。通常情况下，医生并不认为自己的错误率是一个问题，而且通常会低估他们诊断错误的可能性。医生承认存在诊断错误，但认为错误的可能性比实际情况要小。他们相信，就个人而言，他们不太可能犯错误。在这篇社论中，我们检查并比较了放射科医生和急诊医生的诊断领域以及他们如何互动。特别是，我们研究的条件和因素，有助于在这两个相互依赖的医学领域的诊断错误。
Diagnostic error is now firmly on the radar. It represents a notable and costly proportion of all medical errors and medicolegal claims, andmay result in devastating consequences for patients, relatives and healthcare professionals. Diagnostic error exists at an appreciable rate, up to 15% in most areas of medicine, with lower rates in the ‘perceptual’ specialties. However, rates of error and variation of greater than 15% have been described in some published medical imaging work, although not all errors result in patient harm and there is also the issue of retrospective review. There is also the distinction between error and variability in medical imaging interpretation, namely not all variability is due to error. TheQuality inAustralianHealthCareStudy identified2351 adverse events related to hospitalization, of which 20% represented delays in diagnosis or treatment and 15.8% reflected a failure to ‘synthesize/decide/act on’ information. Recently, diagnostic error has caught the attention of patient safety organizations. In 2008, the US Agency for Healthcare Research and Quality (AHRQ) announced that it intends to support research designed to gain better insight into the incidence, cost, determinants and strategies for preventing or mitigating diagnostic failures. Decisions in medicine are often made under conditions of uncertainty. Doctors misdiagnose patients, despite significant improvements in diagnostic technology, including advanced imaging techniques. Complex models have been proposed for the classification of these errors. Most doctors and trainees, however, have limited insight into the cognitive and systems-based underpinnings of diagnostic error. Furthermore, they are often unaware of techniques that might prevent these errors. Until relatively recently, diagnostic error has escaped close scrutiny and study because it is not easily understood or measured, and is difficult to identify, sometimes unfolding over a long time period. It is often regarded as a failure of the individual practitioner rather than an organizational or systemic issue. Typically, doctors do not perceive their own error rates as a problem and, in general, underestimate the likelihood that their diagnoses are incorrect. Doctors acknowledge that diagnostic error exists, but believe that the likelihood of error is less than it really is. They believe that they, personally, are unlikely to make a mistake. In the present editorial, we examine and compare the diagnostic universes of the radiologist and the emergency physician and how they interact. In particular, we examine the conditions and factors that contribute to diagnostic error in these two co-dependent areas of medicine.