Department of General Medicine, 37028 NHO Kumamoto Medical Center , Kumamoto, Japan.
Medicine Service, 20034 Veterans Affairs Ann Arbor Healthcare System , Ann Arbor, MI, USA.
Diagnosis (Berl). 2024 Mar 20;11(3):273-282. doi: 10.1515/dx-2023-0131. eCollection 2024 Aug 1.
To analyze the Big Three diagnostic errors (malignant neoplasms, cardiovascular diseases, and infectious diseases) through internists' self-reflection on their most memorable diagnostic errors.
This secondary analysis study, based on a web-based cross-sectional survey, recruited participants from January 21 to 31, 2019. The participants were asked to recall the most memorable diagnostic error cases in which they were primarily involved. We gathered data on internists' demographics, time to error recognition, and error location. Factors causing diagnostic errors included environmental conditions, information processing, and cognitive bias. Participants scored the significance of each contributing factor on a Likert scale (0, unimportant; 10, extremely important).
The Big Three comprised 54.1 % (n=372) of the 687 cases reviewed. The median physician age was 51.5 years (interquartile range, 42-58 years); 65.6 % of physicians worked in hospital settings. Delayed diagnoses were the most common among malignancies (n=64, 46 %). Diagnostic errors related to malignancy were frequent in general outpatient settings on weekdays and in the mornings and were not identified for several months following the event. Environmental factors often contributed to cardiovascular disease-related errors, which were typically identified within days in emergency departments, during night shifts, and on holidays. Information gathering and interpretation significantly impacted infectious disease diagnoses.
The Big Three accounted for the majority of cases recalled by Japanese internists. The most relevant contributing factors were different for each of the three categories. Addressing these errors may require a unique approach based on the disease associations.
通过内科医生对自己最难忘的诊断错误进行自我反思，分析三大诊断错误（恶性肿瘤、心血管疾病和传染病）。
本二次分析研究基于一项基于网络的横断面调查，于 2019 年 1 月 21 日至 31 日招募参与者。参与者被要求回忆他们主要参与的最难忘的诊断错误案例。我们收集了内科医生人口统计学、错误识别时间和错误位置的数据。导致诊断错误的因素包括环境条件、信息处理和认知偏差。参与者对每个促成因素的重要性进行了李克特量表评分（0，不重要；10，非常重要）。
三大诊断错误占审查的 687 例中的 54.1%（n=372）。医生的中位年龄为 51.5 岁（四分位距，42-58 岁）；65.6%的医生在医院工作。恶性肿瘤中最常见的是延迟诊断（n=64，46%）。恶性肿瘤相关的诊断错误在普通门诊的工作日和上午更为常见，并且在事件发生后的几个月内都未被发现。环境因素常导致心血管疾病相关的错误，这些错误通常在急诊科、夜班和节假日的几天内被识别。信息收集和解释对传染病诊断有重大影响。
日本内科医生回忆的病例中，三大诊断错误占大多数。这三个类别中最相关的促成因素各不相同。针对这些错误，可能需要根据疾病相关性采取独特的方法。
