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

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The global burden of diagnostic errors in primary care

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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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Figure 1 Relationships between diagnostic errors, missed opportunities and patient harm (adapted from Singh H).18CC BY-NC · PubMed Central

Figure 2 Potential interventions to reduce global burden of diagnostic errors. IT, information technology; POCT, point-of-care testing.CC BY-NC · PubMed Central

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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: Singh, Hardeep
Schiff, Gordon D
Graber, Mark L
Onakpoya, Igho
Thompson, Matthew J
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: hybrid
doi.org
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 › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
Health Sciences › Medicine › Family Practice › 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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