Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care
Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care
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DOI：
10.3399/bjgp15x687889
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发表时间：
2015-12-01
影响因子：
5.9
通讯作者：
Thompson, Matthew J.
中科院分区：
文献类型：
--
作者：
Goyder, Clare R.;Jones, Caroline H. D.;Thompson, Matthew J.
由于初级保健诊断的固有困难，诊断错误不可避免地会发生。然而，尽管与诊断错误及其估计的高患病率相关的重要后果，但诊断错误的教学和研究是一个被忽视的领域。UK.MethodTwo datasets of semi-structured interviews were combined.问题集中在全科医生在常规初级保健和非工作时间的诊断和诊断错误（或未遂）的经验。访谈录音，逐字转录，并分析thematics.ResultsLearning点，包括全科医生的依赖“模式识别”和失败的这一战略，以确定非典型的介绍，考虑所有潜在的严重条件的重要性，使用“限制排除”的方法，并确定和行动的不安感。策略，以帮助管理不确定性在初级care.ConclusionLearning从以前的诊断错误的例子是必不可少的，如果这些事件要减少在未来，这应该被纳入GP培训。在实践层面，应更频繁地讨论从诊断错误的经验中吸取的教训;应做更多的工作，在全国范围内整合这些教训，以了解和纠正诊断错误。
BackgroundBecause of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area.AimTo ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these.Design and settingSecondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK.MethodTwo datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically.ResultsLearning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed.ConclusionLearning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors.