ArticleBMJ open2012
Identifying early warning signs for diagnostic errors in primary care: a qualitative study.
Article in BMJ open, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Effectiveness of Electronic Differential Diagnoses (DDX) Generators: A Systematic Review and Meta-Analysis.PloS one · 2016Pooled it
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- GPs' understanding and practice of safety netting for potential cancer presentations: a qualitative study in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Article
- [Cognitive errors in diagnostic decision making].Wiener medizinische Wochenschrift (1946) · 2017Review
- The Importance of Framing.Journal of general internal medicine · 2017Article
- The global burden of diagnostic errors in primary care.BMJ quality & safety · 2017Review
- Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study.BMJ open · 2017Article
- The Role of Physicians' First Impressions in the Diagnosis of Possible Cancers without Alarm Symptoms.Medical decision making : an international journal of the Society for Medical Decision Making · 2017Article
- Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2015Article
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Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveWe investigate the mechanisms of diagnostic error in primary care consultations to detect warning signs for possible error. We aim to identify places in the diagnostic reasoning process associated with major risk indicators.
designA qualitative study using semistructured interviews with open-ended questions.
settingA 2-month study in primary care conducted in Oxfordshire, UK.
participantsWe approached about 25 experienced general practitioners by email or word of mouth, 15 volunteered for the interviews and were available at a convenient time.
interventionInterview transcripts provided 45 cases of error. Three researchers searched these independently for underlying themes in relation to our conceptual framework. OUTCOME MEASURES: Locating steps in the diagnostic reasoning process associated with major risk of error and detecting warning signs that can alert clinicians to increased risk of error.
resultsInitiation and closure of the cognitive process are most exposed to risk of error. Cognitive biases developed early in the process lead to errors at the end. These warning signs can be used to alert clinicians to the increased risk of diagnostic error. Ignoring red flags or critical cues was related to processes being biased through the initial frame, but equally well, it could be explained by knowledge gaps.
conclusionsCognitive biases developed at the initial framing of the problem relate to errors at the end of the process. We refer to these biases as warning signs that can alert clinicians to the increased risk of diagnostic error. We conclude that lack of knowledge is likely to be an important factor in diagnostic error. Reducing diagnostic errors in primary care should focus on early and systematic recognition of errors including near misses, and a continuing professional development environment that promotes reflection in action to highlight possible causes of process bias and of knowledge gaps.
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Registered trials
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