Missed and Delayed Diagnoses in the Ambulatory Setting
Authors: Eta S. Berner, Randolph A. Miller, Mark L. Graber
Journal: Annals of Internal Medicine (2007)

Letters20 March 2007Missed and Delayed Diagnoses in the Ambulatory SettingEta S. Berner, EdD, Randolph A. Miller, MD, and Mark L. Graber, MDEta S. Berner, EdDFrom the University of Alabama at Birmingham, Birmingham, AL 35294; Vanderbilt University, Nashville, TN 37232; and State University of New York at Stony Brook and Veterans Affairs Medical Center, Northport, NY 11768., Randolph A. Miller, MDFrom the University of Alabama at Birmingham, Birmingham, AL 35294; Vanderbilt University, Nashville, TN 37232; and State University of New York at Stony Brook and Veterans Affairs Medical Center, Northport, NY 11768., and Mark L. Graber, MDFrom the University of Alabama at Birmingham, Birmingham, AL 35294; Vanderbilt University, Nashville, TN 37232; and State University of New York at Stony Brook and Veterans Affairs Medical Center, Northport, NY 11768.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-6-200703200-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: We applaud Gandhi and colleagues (1) for highlighting the problem of outpatient diagnostic errors. However, malpractice claims are a biased data source. Primary identification of diagnostic errors in ambulatory settings remains problematic.Wachter (2) highlighted differences that make diagnostic error detection more difficult in ambulatory settings than in hospitals. Outpatient diagnosticians typically record their observations and conclusions incompletely and illegibly on paper charts, which contributes to the lack of knowledge about the extent of diagnostic errors. Paper-based outpatient records are expensive to collect and analyze for outcome studies. In outpatient settings, fewer diagnostic gold standard procedures occur ...References1. Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006;145:488-96. LinkGoogle Scholar2. Wachter RM. Wachter RM. Is ambulatory patient safety just like hospital safety, only without the "stat"? [Editorial]. Ann Intern Med. 2006;145:547-9. LinkGoogle Scholar3. Miller RA. Medical diagnostic decision support systems—past, present, and future: a threaded bibliography and brief commentary. J Am Med Inform Assoc. 1994;1:8-27. CrossrefMedlineGoogle Scholar4. Miller RA, Giuse NB. Medical knowledge bases. Acad Med. 1991;66:15-7. CrossrefMedlineGoogle Scholar5. Graber M. Diagnostic errors in medicine: a case of neglect. Jt Comm J Qual Patient Saf. 2005;31:106-13. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Eta S. Berner, EdD; Randolph A. Miller, MD; Mark L. Graber, MDAffiliations: From the University of Alabama at Birmingham, Birmingham, AL 35294; Vanderbilt University, Nashville, TN 37232; and State University of New York at Stony Brook and Veterans Affairs Medical Center, Northport, NY 11768.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMissed and Delayed Diagnoses in the Ambulatory Setting: A Study of Closed Malpractice Claims Tejal K. Gandhi , Allen Kachalia , Eric J. Thomas , Ann Louise Puopolo , Catherine Yoon , Troyen A. Brennan , and David M. Studdert Is Ambulatory Patient Safety Just Like Hospital Safety, Only without the "Stat"? Robert M. Wachter Missed and Delayed Diagnoses in the Ambulatory Setting Tejal K. Gandhi , Allen Kachalia , and David M. Studdert Missed and Delayed Diagnoses in the Ambulatory Setting Thomas P. Clairmont Jr. Missed and Delayed Diagnoses in the Ambulatory Setting Joseph E. Marine Metrics Cited byDetermining pediatric hypertension criteria: concordance between observed physician methods and guideline-recommended methodsAcute kidney injury as a risk factor for diagnostic discrepancy among geriatric patients: a pilot studyThe Impact of Procedural Sedation on Diagnostic Errors in Pediatric EchocardiographyPaperless reporting and electronically verifying clinical investigationsDiagnostic Errors in Congenital Echocardiography: Importance of Study ConditionsExamining the Diagnostic Justification Abilities of Fourth-Year Medical StudentsDiagnosis, Diagnostic Criteria, and ConsensusDiagnostic Errors in Pediatric EchocardiographyOverconfidence as a Cause of Diagnostic Error in Medicine 20 March 2007Volume 146, Issue 6Page: 470KeywordsChartsClinical decision support systemsConflicts of interestElectronic medical recordsInformation storage and retrievalOutpatientsPerception ePublished: 20 March 2007 Issue Published: 20 March 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...