The Challenges in Defining and Measuring Diagnostic Error
Open accessAbstract
Diagnostic errors have emerged as a serious patient safety problem but they are hard to detect and complex to define. At the research summit of the 2013 Diagnostic Error in Medicine 6th International Conference, we convened a multidisciplinary expert panel to discuss challenges in defining and measuring diagnostic errors in real-world settings. In this paper, we synthesize these discussions and outline key research challenges in operationalizing the definition and measurement of diagnostic error. Some of these challenges include 1) difficulties in determining error when the disease or diagnosis is evolving over time and in different care settings, 2) accounting for a balance between underdiagnosis and overaggressive diagnostic pursuits, and 3) determining disease diagnosis likelihood and severity in hindsight. We also build on these discussions to describe how some of these challenges can be addressed while conducting research on measuring diagnostic error.
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The complexity of defining and quantifying diagnostic error shows that this area is largely overlooked in patient safety compared to other quality concerns, including infection, wrong-site surgery, and adverse drug events.
“The complexity of defining and quantifying diagnostic error shows that this area is largely overlooked in the field of patient safety when compared to other quality concerns, including infection, wrong-site surgery, and adverse drug events [4,6,7].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [4]
The Introduction says diagnostic errors are only beginning to emerge prominently in patient-safety literature and that inconsistent definitions make prevalence studies difficult to compare. This supports the claim about measurement complexity and relative lack of attention, but the paper does not make the specific comparison with infections, wrong-site surgery, and adverse drug events or establish that measurement complexity caused the neglect. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe unpredictable and evolving nature of disease conditions makes diagnostic safety more challenging to address than other healthcare safety issues, such as medication and surgical errors.
“The unpredictable and evolving nature of disease conditions makes diagnostic safety more challenging to address [4] than other healthcare safety issues, such as medication and surgical errors [1,5].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [4]
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Blease, C., O’Neill, S. F., Torous, J. B., DesRoches, C. M., & Hägglund, M. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001303 · Cited by 26 · see citing works
Hooftman, J., Dijkstra, A. C., Suurmeijer, I., van der Bij, A., Paap, E., & Zwaan, L. (2024) · BMJ Quality & Safety · doi:10.1136/bmjqs-2022-015876 · Cited by 25 · see citing works
Self-citationGiardina, T. D., Shahid, U., Mushtaq, U., Upadhyay, D. K., Marinez, A., & Singh, H. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-022-07554-w · Cited by 24 · see citing works
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Dregmans, E., Kaal, A. G., Meziyerh, S., Kolfschoten, N. E., van Aken, M. O., Schippers, E. F., Steyerberg, E. W., & van Nieuwkoop, C. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.18172 · Cited by 21 · see citing works
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Denkfehler bei diagnostischen Entscheidungen
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Errors in Diagnosing Infectious Diseases: A Physician Survey
Haddad, M., Sheybani, F., Naderi, H., Sasan, M. S., Najafi, M. N., Sedighi, M., & Seddigh, A. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.779454 · Cited by 15 · see citing works
Cheraghi‐Sohi, S., Singh, H., Reeves, D., Stocks, S. J., Morris, R., Esmail, A., Campbell, S., & de Wet, C. (2015) · Implementation Science · doi:10.1186/s13012-015-0296-z · Cited by 15 · see citing works
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Self-citationMalik, M. A., Motta-Calderon, D., Piniella, N. R., Garber, A., Konieczny, K., Lam, A., Plombon, S., Carr, K., Yoon, C. S., Griffin, J. A., et al. (2022) · Diagnosis · doi:10.1515/dx-2022-0032 · Cited by 14 · see citing works
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Singh, H., Mushtaq, U., Marinez, A., Shahid, U., Huebner, J., McGaffigan, P., & Upadhyay, D. K. (2022) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2022.08.003 · Cited by 13 · see citing works
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Artificial intelligence for digital healthcare in the low and medium income countries
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Self-citationDiagnostic Discrepancies in the Emergency Department: A Retrospective Study
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Frequent Missed Opportunities for Earlier Diagnosis of Advanced-Stage Colorectal or Lung Cancer
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Diagnostic errors in the neonatal intensive care unit: State of the science and new directions
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Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors
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Framing diagnostic error: an epidemiological perspective
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- Authors
- Zwaan, L., & Singh, H.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Corresponding author
- Zwaan, Laura
- Venue
- Diagnosis
- Publisher
- Walter de Gruyter GmbH
- Published
- 2015-03-12
- Volume
- 2
- Issue
- 2
- Pages
- 97-103
- ISSN
- 2194-8011 (ISSN-L)
- 2194-802X
- PMC
- PMC4779119
- OpenAlex
- W2062974444
- Cited by
- 173
- References
- 47
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 16 · 2023: 18 · 2022: 19 · 2021: 25 · 2020: 15 · 2019: 14 · 2018: 14 · 2017: 11 · 2016: 9 · 2015: 6
- FWCI
- 15.57
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diagnosis (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- PubMed Central (acceptedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (R13HS021774, R01HS022087)
- National Cancer Institute (K23CA125585)
- 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 › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- diagnostic errors, patient safety, underdiagnosis, retrospective diagnosis
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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