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Cited by 98Clinical Reasoning and Diagnostic SkillsPatient Safety and Medication ErrorsHealthcare cost, quality, practices

A Unified Conceptual Model for Diagnostic Errors: Underdiagnosis, Overdiagnosis, and Misdiagnosis

Open access
Newman-Toker, David E.·2014·Diagnosis
DOI 10.1515/dx-2013-0027PMC PMC5373075
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Abstract

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.

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  • Many diagnostic guidelines are incomplete and have limitations including lack of clear definitions, inadequate consideration for comorbidities, and lacking standardized testing methods.

    “However, many diagnostic guidelines are incomplete and have several limitations, including a lack of clear definitions [141,142], inadequate consideration for comorbidities [143,144], and lacking standardized testing methods [145,146].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [142]

    The Conclusions (page unavailable) say that diagnostic-error concepts have blurry boundaries and need consensus on key definitions, supporting the concern about unclear definitions. The paper does not establish that many diagnostic guidelines lack clear definitions; the comorbidity and testing-method limitations are attached to other citations in the citing sentence. (LLM, conf=0.82)

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Authors
Newman-Toker, D. E.
Venue
Diagnosis
Publisher
Walter de Gruyter GmbH
Published
2014-01-01
Volume
1
Issue
1
Pages
43-48
ISSN
  • 2194-8011 (ISSN-L)
  • 2194-802X
DOI
10.1515/dx-2013-0027
PMC
PMC5373075
OpenAlex
W1985672878
Cited by
97
References
35
Citations by year
2026: 4 · 2025: 5 · 2024: 7 · 2023: 12 · 2022: 8 · 2021: 17 · 2020: 8 · 2019: 15 · 2018: 10 · 2017: 6 · 2016: 1 · 2015: 3 · 2014: 1
FWCI
3.78
Type
journal article
Language
en
Open access
Licence
Locations
  • Diagnosis (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
Agency for Healthcare Research and Quality (R13HS019252)
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 › Healthcare cost, quality, practices
Keywords
diagnostic errors, underdiagnosis, overdiagnosis, misdiagnosis, unnecessary testing, terminology and definitions, harm mitigation, medical safety

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