Newman-Toker David E
1Associate Professor, Department of Neurology, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital Meyer Building 8-154 600 North Wolfe Street, Baltimore, MD 21287, USA.
Diagnosis (Berl). 2014 Jan;1(1):43-48. doi: 10.1515/dx-2013-0027. Epub 2014 Jan 8.
Progress in diagnostic error research has been hampered by a lack of unified terminology and definitions. This article proposes a novel framework for considering diagnostic errors, offering a unified conceptual model for underdiagnosis, overdiagnosis, and misdiagnosis. The model clarifies the critical separation between 'diagnostic process failures' (incorrect workups) and 'diagnosis label failures' (incorrect diagnoses). By dividing processes into those that are substandard, suboptimal, or optimal, important distinctions are drawn between 'preventable', 'reducible,' and 'unavoidable' diagnostic errors. The new model emphasizes the importance of mitigating diagnosis-related harms, regardless of whether the solutions require traditional safety strategies (preventable errors), more effective evidence dissemination (reducible errors; harms from overtesting and overdiagnosis), or new scientific discovery (currently unavoidable errors). Doing so maximizes our ability to prioritize solving various diagnosis-related problems from a societal value perspective. This model should serve as a foundation for developing consensus terminology and operationalized definitions for relevant diagnostic-error categories.
诊断错误研究的进展因缺乏统一的术语和定义而受阻。本文提出了一个用于考量诊断错误的新颖框架，为漏诊、过度诊断和误诊提供了一个统一的概念模型。该模型明确了“诊断过程失败”（检查不当）和“诊断标签失败”（诊断错误）之间的关键区别。通过将过程分为不合标准、次优或最优的过程，在“可预防”、“可减少”和“不可避免”的诊断错误之间划出了重要区别。新模型强调减轻与诊断相关危害的重要性，无论解决方案是需要传统的安全策略（可预防的错误）、更有效的证据传播（可减少的错误；过度检查和过度诊断造成的危害）还是新的科学发现（目前不可避免的错误）。这样做能最大限度地提高我们从社会价值角度对解决各种与诊断相关问题进行优先级排序的能力。该模型应作为为相关诊断错误类别制定共识术语和可操作定义的基础。
