The DOI matches its Crossref record; 46 of the 46 references it cites were found in a registry or an index.
Diagnostic Error in Internal Medicine
Abstract
BACKGROUND: The goal of this study was to determine the relative contribution of system-related and cognitive components to diagnostic error and to develop a comprehensive working taxonomy. METHODS: One hundred cases of diagnostic error involving internists were identified through autopsy discrepancies, quality assurance activities, and voluntary reports. Each case was evaluated to identify system-related and cognitive factors underlying error using record reviews and, if possible, provider interviews. RESULTS: Ninety cases involved injury, including 33 deaths. The underlying contributions to error fell into 3 natural categories: "no fault," system-related, and cognitive. Seven cases reflected no-fault errors alone. In the remaining 93 cases, we identified 548 different system-related or cognitive factors (5.9 per case). System-related factors contributed to the diagnostic error in 65% of the cases and cognitive factors in 74%. The most common system-related factors involved problems with policies and procedures, inefficient processes, teamwork, and communication. The most common cognitive problems involved faulty synthesis. Premature closure, ie, the failure to continue considering reasonable alternatives after an initial diagnosis was reached, was the single most common cause. Other common causes included faulty context generation, misjudging the salience of findings, faulty perception, and errors arising from the use of heuristics. Faulty or inadequate knowledge was uncommon. CONCLUSIONS: Diagnostic error is commonly multifactorial in origin, typically involving both system-related and cognitive factors. The results identify the dominant problems that should be targeted for additional research and early reduction; they also further the development of a comprehensive taxonomy for classifying diagnostic errors.
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In the citing paper
“Although many contributors to diagnostic error have been identified in the previous literature, they are typically discussed in isolation rather than as part of an interacting system [25,33].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [33]
In the citing paper
“Previous exploratory studies in patient safety have been able to shed powerful light on contributory factors with a similar sample size.44”
From An analysis of electronic health record-related patient safety concerns (2014) · cites this paper as [44]
In the citing paper
“missed laboratory results or delayed recognition of results leads to a significant potential for outpatient diagnostic errors, adverse events and liability claims.”
From Notification of Abnormal Lab Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain? (2010) · cites this paper as [14]
In the citing paper
“Although diagnostic errors may occur when signs of a disease are atypical or absent, diagnostic errors are often attributed to cognitive (e.g., faulty clinical reasoning) and/or systems-related factors (e.g., inefficient processes and poor communication7,9–21).”
From Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology (2008) · cites this paper as [7]
In the citing paper
“Evidence suggests that the most common medical error results from inadequate clinical reasoning [3, 9].”
From The virtual patient as a learning tool: a mixed quantitative qualitative study (2018) · cites this paper as [3]
In the citing paper
“Current evidence suggests that medical error represents one of the leading causes of death [1–3].”
From The virtual patient as a learning tool: a mixed quantitative qualitative study (2018) · cites this paper as [3]
Citations
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The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them
Croskerry, P. (2003) · Academic Medicine · doi:10.1097/00001888-200308000-00003 · Cited by 1,675
Brown, A. B., & Patterson, D. A. (2001) · Cited by 1,390
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Croskerry, P. (2002) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2002.tb01574.x · Cited by 938
The Value of the Autopsy in Three Medical Eras
Goldman, L., Sayson, R., Robbins, S. L., Cohn, L. H., Bettmann, M. A., & Weisberg, M. C. (1983) · New England Journal of Medicine · doi:10.1056/nejm198304283081704 · Cited by 812
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Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors
Bradford, A., Kunik, M. E., Schulz, P., Williams, S. P., & Singh, H. (2009) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e3181a6bebc · Cited by 969
Overconfidence as a Cause of Diagnostic Error in Medicine
Berner, E. S., & Graber, M. L. (2008) · The American Journal of Medicine · doi:10.1016/j.amjmed.2008.01.001 · Cited by 1,034
Metadata
- Authors
- Graber, M. L., Franklin, N., & Gordon, R.
- Affiliations
- Northport VA Medical Center (US)
- ORCID
- Graber, Mark L.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2005-07-11
- Volume
- 165
- Issue
- 13
- Pages
- 1493
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2141222241
- Cited by
- 1,549
- References
- 45
- Citations by year
- 2026: 109 · 2025: 74 · 2024: 92 · 2023: 112 · 2022: 115 · 2021: 130 · 2020: 82 · 2019: 92 · 2018: 77 · 2017: 78 · 2016: 62 · 2015: 83 · 2014: 71 · 2013: 83 · 2012: 67
- FWCI
- 16.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Medicine › Pathology and Forensic Medicine › Autopsy Techniques and Outcomes
- Keywords
- diagnostic errors, internal medicine, cognitive factors, premature closure, heuristics, teamwork and communication, medical errors
- MeSH terms
- Australia, Diagnostic Errors, Humans, Internal Medicine, Interviews as Topic, Practice Patterns, Physicians', Quality Assurance, Health Care, Cognitive Science
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