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Cited by 395Clinical Reasoning and Diagnostic SkillsPatient Safety and Medication ErrorsPrimary Care and Health Outcomes

The Global Burden of Diagnostic Errors in Primary Care

Open access
Singh, Hardeep, Schiff, Gordon D, Graber, Mark L, Onakpoya, Igho, Thompson, Matthew J·2017·BMJ Quality & Safety
DOI 10.1136/bmjqs-2016-005401PMC PMC5502242
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Abstract

Diagnosis is one of the most important tasks performed by primary care physicians. The World Health Organization (WHO) recently prioritized patient safety areas in primary care, and included diagnostic errors as a high-priority problem. In addition, a recent report from the Institute of Medicine in the USA, ‘Improving Diagnosis in Health Care’, concluded that most people will likely experience a diagnostic error in their lifetime. In this narrative review, we discuss the global significance, burden and contributory factors related to diagnostic errors in primary care. We synthesize available literature to discuss the types of presenting symptoms and conditions most commonly affected. We then summarize interventions based on available data and suggest next steps to reduce the global burden of diagnostic errors. Research suggests that we are unlikely to find a ‘magic bullet’ and confirms the need for a multifaceted approach to understand and address the many systems and cognitive issues involved in diagnostic error. Because errors involve many common conditions and are prevalent across all countries, the WHO’s leadership at a global level will be instrumental to address the problem. Based on our review, we recommend that the WHO consider bringing together primary care leaders, practicing frontline clinicians, safety experts, policymakers, the health IT community, medical education and accreditation organizations, researchers from multiple disciplines, patient advocates, and funding bodies among others, to address the many common challenges and opportunities to reduce diagnostic error. This could lead to prioritization of practice changes needed to improve primary care as well as setting research priorities for intervention development to reduce diagnostic error.

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  • Diagnostic processes differ across care settings in terms of workflow, communication needs, and resources.

    “Since diagnostic processes differ across care settings in terms of workflow, communication needs, and resources, organizational strategies for diagnostic safety should be tailored to each specific setting [373,374].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [374]

    The Introduction describes primary-care diagnostic workflow, and the Epidemiology section contrasts diagnostic resources in low- and high-resource settings. The paper also identifies communication and coordination as diagnostic-process concerns, but it does not clearly establish that workflow and communication needs differ across care settings or explicitly call for organizational strategies tailored to each setting. Page numbers were not available in our copy. (LLM, conf=0.80)

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1 of the 114 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [100]Graber ML Reducing diagnostic error in medicine – there's a job for everyone. NPSF Focus Patient Saf 2009; 12: 6– 7.
  2. [107]Lorincz CY, Drazen E, Sokol PE, et al Research in Ambulatory Patient Safety 2000–2010: A 10-Year Review. American Medical Association, 2011.

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Authors
Singh, H., Schiff, G. D., Graber, M. L., Onakpoya, I., & Thompson, M. J.
Affiliations
  • Michael E. DeBakey VA Medical Center (US)
  • Brigham and Women's Hospital (US)
  • RTI International (US)
  • University of Oxford (GB)
  • University of Washington (US)
Corresponding author
Singh, Hardeep
ORCID
Venue
BMJ Quality & Safety
Publisher
BMJ
Published
2016-08-16
Volume
26
Issue
6
Pages
484-494
ISSN
  • 1475-3898 (ISSN-L)
  • 2044-5415
  • 2044-5423
DOI
10.1136/bmjqs-2016-005401
PMC
PMC5502242
OpenAlex
W2517618195
Cited by
395
References
114
Citations by year
2026: 30 · 2025: 50 · 2024: 58 · 2023: 52 · 2022: 48 · 2021: 63 · 2020: 45 · 2019: 24 · 2018: 17 · 2017: 5 · 2016: 2
FWCI
19.51
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Quality & Safety (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Health Services Research and Development
  • Agency for Healthcare Research and Quality (R21HS023602, R01HS022087)
  • VA National Center for Patient Safety
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
diagnostic errors, primary care, patient safety, global burden, presenting symptoms, World Health Organization, research priorities, medical education
MeSH terms
Clinical Decision-Making, Diagnostic Errors, Education, Medical, Health Policy, Humans, Information Systems, Patient Participation, Primary Health Care, Global Health, World Health Organization, Risk Assessment, Diagnostic Techniques and Procedures, Quality Improvement, Patient Safety

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