The DOI matches its Crossref record; 47 of the 47 references it cites were found in a registry or an index.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Incidence of Adverse Events and Negligence in Hospitalized Patients
Brennan, T. A., Leape, L. L., Laird, N. M., Hebert, L. E., Localio, A. R., Lawthers, A. G., Newhouse, J. P., Weiler, P. C., & Hiatt, H. H. (1991) · New England Journal of Medicine · doi:10.1056/nejm199102073240604 · Cited by 4,631
The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada
Baker, G. R. (2004) · Canadian Medical Association Journal · doi:10.1503/cmaj.1040498 · Cited by 2,337
Chow, C. K. (2013) · JAMA · doi:10.1001/jama.2013.184182 · Cited by 2,000
Welch, H. G., & Black, W. C. (2010) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djq099 · Cited by 1,627
Diagnostic error in internal medicine
Graber, M. L., Franklin, N., & Gordon, R. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.13.1493 · Cited by 1,549
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
Time Trends in Pulmonary Embolism in the United States
Wiener, R. S., Schwartz, L. M., & Woloshin, S. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.178 · Cited by 687
Singh, H., Meyer, A. N. D., & Thomas, E. J. (2014) · BMJ Quality & Safety · doi:10.1136/bmjqs-2013-002627 · Cited by 677
Self-citationPreventing overdiagnosis: how to stop harming the healthy
Moynihan, R., Doust, J., & Henry, D. (2012) · BMJ · doi:10.1136/bmj.e3502 · Cited by 675
Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors
Schiff, G. D. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.333 · Cited by 638
Flagged first, then by citations
Cited by
Sorted by citations
Items 101–174 of 174
Monitoring Diagnostic Safety Risks in Emergency Departments: Protocol for a Machine Learning Study
Enayati, M., Sır, M. Y., Zhang, X., Parker, S. J., Duffy, E. A., Singh, H., Mahajan, P., & Pasupathy, K. S. (2021) · JMIR Research Protocols · doi:10.2196/24642 · Cited by 6
Self-citationThe influence of viewing time on visual diagnostic accuracy: Less is more
Monteiro, S., Sherbino, J., LoGiudice, A. B., Lee, M., Norman, G. R., & Sibbald, M. (2024) · Medical Education · doi:10.1111/medu.15380 · Cited by 6
Huang, C., Barwise, A. K., Soleimani, J., Dong, Y., Svetlana, H., Khan, S. A., Gavin, A., Helgeson, S. A., Moreno-Franco, P., Pinevich, Y., et al. (2021) · Journal of Patient Safety · doi:10.1097/pts.0000000000000840 · Cited by 6
Miller, A. C., Arakkal, A. T., Koeneman, S., Cavanaugh, J. E., & Polgreen, P. M. (2022) · Diagnosis · doi:10.1515/dx-2022-0044 · Cited by 5
Providers’ and Patients’ Perspectives on Diagnostic Errors in the Acute Care Setting
Schnock, K. O., Garber, A., Fraser, H., Carnie, M. B., Schnipper, J. L., Dalal, A. K., Bates, D. W., & Rozenblum, R. (2022) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2022.11.009 · Cited by 5
Reducing Diagnostic Uncertainty Using Large Language Models
Finkelstein, J., Cui, W., Morgan, K. L., & Kawamoto, K. (2024) · IEEE International Conference on Artificial Intelligence for Medicine, Health and Care (AIMHC) · doi:10.1109/aimhc59811.2024.00049 · Cited by 6
Hagström, J., Hägglund, M., & Blease, C. (2025) · BMC Medical Ethics · doi:10.1186/s12910-025-01182-9 · Cited by 5
El error diagnóstico en atención primaria
Minué-Lorenzo, S. (2016) · Atención Primaria · doi:10.1016/j.aprim.2016.10.003 · Cited by 5
Two decades of diagnostic safety research: advances, challenges, and next steps
Khan, S., Bradford, A. M., Cifra, C. L., & Singh, H. (2025) · Diagnosis · doi:10.1515/dx-2025-0124 · Cited by 4
Self-citationde Jesus, M. S., Cruz, J. V. A., Coelho, L. B., Borja, L. S., da Silva, E. D., Solcà, M. D. S., Brodskyn, C., & Fraga, D. B. M. (2021) · Parasites & Vectors · doi:10.1186/s13071-021-04895-z · Cited by 4
Action for cognitive biases in clinical decision-making
Cioffi, J. M. (2025) · Academia Medicine · doi:10.20935/acadmed7526 · Cited by 5
Chien, L. J., Kwan, J. L., Cifra, C. L., Liberman, A. L., Haskell, H. W., McDonald, K. M., Schrandt, M. S., Jones, R., Olson, A. P. J., Bonifacino, E., et al. (2025) · Diagnosis · doi:10.1515/dx-2025-0120 · Cited by 4
Mihailović, N., Vasiljević, D., Milicic, V. M., Sunjka, M. L., Radovanovi, S., Miličić, B., & Kocic, S. S. (2020) · Iranian Journal of Public Health · doi:10.18502/ijph.v49i12.4818 · Cited by 4
A Machine Learning Framework for Assessing Experts’ Decision Quality
Dong, W., Saar‐Tsechansky, M., & Geva, T. (2024) · Management Science · doi:10.1287/mnsc.2021.03357 · Cited by 6
Fidopiastis, C., Venta, K. E., Baker, E. G., & Stanney, K. M. (2018) · Military Medicine · doi:10.1093/milmed/usx203 · Cited by 4
Emergency medicine as risk management: a cognitive scaffold for safe decisions under uncertainty
Jain, A., Bhoi, S. K., & Amrithanand, V. T. (2026) · Emergency Medicine Journal · doi:10.1136/emermed-2026-215940 · Cited by 3
Insights into diagnostic errors in endocrinology: a prospective, case-based, international study
Frey, J., Braun, L., Handgriff, L., Kendziora, B., Fischer, M. R., Reincke, M., Zwaan, L., & Schmidmaier, R. (2023) · BMC Medical Education · doi:10.1186/s12909-023-04927-5 · Cited by 3
Self-citationHofmann, B., & Lysdahl, K. B. (2020) · SpringerBriefs in ethics · doi:10.1007/978-3-030-61412-6_2 · Cited by 3
Shipilov, I. S., Bakaev, A. A., Bobokhodzhiev, A. S., Kyagova, D. B., Chotchaev, R. K., Muzafarova, A. I., Golubev, I. U., & Pergunov, S. A. (2023) · Cardiometry · doi:10.18137/cardiometry.2023.27.101110 · Cited by 3
Salinas, M., Flores, E., Blasco, Á., López‐Garrigós, M., Torreblanca, R., Leiva-Salinas, M. D. C., Gutierrez, I., & Leiva‐Salinas, C. (2024) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2024.110730 · Cited by 3
Zwaan, L., & Olson, A. P. J. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.12.076 · Cited by 3
Self-citationExplainable Machine Learning, Patient Autonomy, and Clinical Reasoning
Keeling, G., & Nyrup, R. (2022) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780198857815.013.27 · Cited by 3
Understanding diagnostic error: looking beyond diagnostic accuracy
Heyhoe, J., Lawton, R., Armitage, G., Conner, M. T., & Ashurst, N. H. (2015) · Diagnosis · doi:10.1515/dx-2015-0015 · Cited by 3
Simulation and the diagnostic process: a pilot study of trauma and rapid response teams
Juriga, L. L., Murray, D. J., Boulet, J. R., & Fehr, J. J. (2017) · Diagnosis · doi:10.1515/dx-2017-0010 · Cited by 3
CBOWRA: A Representation Learning Approach for Medication Anomaly Detection
Zhao, L., Ma, Z., Zhou, Y., Wang, K., Liu, S., Gao, J., & Du, W. (2019) · IEEE International Conference on Bioinformatics and Biomedicine (BIBM) · doi:10.1109/bibm47256.2019.8983111 · Cited by 3
The illusion of diagnostic agreement: Institutional bias as a hidden force in modern medicine
Fogt, F. (2025) · Medicinski pregled · doi:10.2298/mpns2508127f · Cited by 3
Peng, C.-C., Lin, C., Woo, P., Tai, H. C.-H., & Feng, C. (2016) · Diagnosis · doi:10.1515/dx-2016-0017 · Cited by 2
A Research Agenda for Diagnostic Excellence in Critical Care Medicine
Cifra, C. L., Custer, J. W., & Fackler, J. C. (2021) · Critical Care Clinics · doi:10.1016/j.ccc.2021.07.003 · Cited by 2
Diagnostic Errors in Hospitalized Patients
Goyal, A. (2023) · Journal of clinical outcomes management · doi:10.12788/jcom.0121 · Cited by 2
Arivanantham, S., Sekar, P., Sundhararajan, N., Nagalingam, Y., & Raju, S. K. (2023) · World Journal of Biology Pharmacy and Health Sciences · doi:10.30574/wjbphs.2023.16.2.0467 · Cited by 2
Defining excellence: next steps for practicing clinicians seeking to prevent diagnostic error
Foster, P. N., & Klein, J. R. (2016) · Journal of Community Hospital Internal Medicine Perspectives · doi:10.3402/jchimp.v6.31994 · Cited by 2
Monitoring the Diagnostic Process on an Inpatient Neurology Service
Dhand, A., Bucelli, R. C., Varadhachary, A. S., Tsiaklides, M., de Bruin, G., & Dhaliwal, G. (2016) · The Neurohospitalist · doi:10.1177/1941874416677681 · Cited by 2
Twelve tips for physicians’ mastering expertise in diagnostic excellence
Shimizu, T. (2023) · MedEdPublish · doi:10.12688/mep.19618.1 · Cited by 2
Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central UgandaPreprint
Katongole, S. P., Akweongo, P., Anguyo, R., Kasozi, D. E., & Adomah-Afari, A. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.09.16.508252 · Cited by 1
Thompson, B. T., Madan, C. R., & Patel, R. M. (2021) · Diagnosis · doi:10.1515/dx-2021-0072 · Cited by 1
Harbingers of sepsis misdiagnosis among pediatric emergency department patients
Sawicki, J. G., Graham, J., Larsen, G. Y., & Workman, J. K. (2024) · Diagnosis · doi:10.1515/dx-2024-0119 · Cited by 1
AI-Enhanced Imaging Techniques for Disease Diagnosis and Monitoring
Vinothkumar, M., Ram, R. S., Vijila, J., & Priya, B. (2025) · Advances in computational intelligence and robotics book series · doi:10.4018/979-8-3373-1275-0.ch019 · Cited by 1
Roos, R., Zwaan, L., Maranus, M. E., Meynaar, I. A., Valk, V. J., van Nieuwkoop, C., Kamps, G.-J., Singh, H., & van Aken, M. O. (2025) · Diagnosis · doi:10.1515/dx-2025-0087 · Cited by 1
Self-citationNiu, W., Fang, J. Y., & Zhang, W. (2026) · Journal of Retailing and Consumer Services · doi:10.1016/j.jretconser.2026.104794 · Cited by 2
How to Avoid Diagnostic Errors by Health Care Professionals
Marcucci, S. (2019) · Acta Scientific Orthopaedics · doi:10.31080/asor.2019.02.0105 · Cited by 1
Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients
Pinevich, Y., Barwise, A. K., Austin, J. M., Soleimani, J., Herasevich, S., Redmond, S. A., Dong, Y., Herasevich, V., Gajic, O., & Pickering, B. W. (2023) · Biomolecules and Biomedicine · doi:10.17305/bb.2022.8393 · Cited by 2
Sloane, J., Singh, H., Upadhyay, D. K., Korukonda, S., Marinez, A., & Giardina, T. D. (2024) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2024.05.011 · Cited by 1
Self-citationВтручання лікарських засобів у лабораторні тести
Бухтіарова, Т. А. (2023) · Pharmacology and Drug Toxicology · doi:10.33250/16.06.363 · Cited by 1
The psychology of diagnostic error
Zwaan, L. (2015) · Experimental Psychology (Russia) · doi:10.17759/exppsy.2015080309
Self-citationChrysikopoulos, H. (2019) · Springer eBooks · doi:10.1007/978-3-030-21103-5_7
Categories of Errors in Imaging
Chrysikopoulos, H. (2019) · Springer eBooks · doi:10.1007/978-3-030-21103-5_3
The Good Physicians for Prospective Diagnosis: The Next Steps
Rémy, N. M. (2018) · Neurodegeneration and Neurorehabilitation · doi:10.31579/2692-9422/003
Gut gegangen – Ganganalyse als Basis einer transdisziplinären Therapie
Götz-Neumann, K., Klein, P., & Kilk, D. (2022) · physiopraxis · doi:10.1055/a-1740-7009
An Interview with Hardeep Singh, MD, MPH
Thomas, E. J. (2022) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2022.06.005
Nabi, U. U., Rafi, A., Maqbool, M., & Shah, P. A. (2022) · Current Medicine Research and Practice · doi:10.4103/cmrp.cmrp_41_22
Wo lauern Gefahren bei Aufklärung und Dokumentation und was sind häufige handwerkliche Fehler?
Enzmann, T., & Pramann, O. (2023) · Die Urologie · doi:10.1007/s00120-023-02033-4
Katongole, S. P., Akweongo, P., Anguyo, R., Kasozi, D. E., & Adomah-Afari, A. (2023) · Research Square · doi:10.21203/rs.3.rs-2505054/v1
Accurate and Explainable Retinal Disease Recognition via DCNFIS
Yeganejou, M., Keshmiri, M., & Dick, S. (2023) · Lecture notes in networks and systems · doi:10.1007/978-3-031-46778-3_1
Quality and safety of acute hospital care for older patients
Schouten, B. (2024) · doi:10.5463/thesis.412
Disease Detection and Treatment Susceptibility by AI
Dhankar, S. (2024) · International Journal for Research in Applied Science and Engineering Technology · doi:10.22214/ijraset.2024.58647 · Cited by 1
Diagnostic test evaluation: Design, measures, classic example
Mdaihly, M. (2025) · Elsevier eBooks · doi:10.1016/b978-0-323-90391-2.00024-5
Dzreke, E., Dzreke, C., Asamoah, R. A., & Kanzin, D. (2025) · Advanced Research Journal · doi:10.71350/3062192585
Diagnostic injustice. What is it, what are its sources, and what can we do about it?
Hofmann, B. (2025) · Diagnosis · doi:10.1515/dx-2025-0099
Hooftman, J., Sikkens, J. J., van Wingerden, N., Beekman, D. G., de Bruijne, M. C., Wagner, C., & Zwaan, L. (2025) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2025.11.006
Self-citationChen, G., Zhang, L., Peng, J., & Jiang, Y. Y. (2025) · Elsevier eBooks · doi:10.1016/b978-0-323-90509-1.00014-x
Additional file 1 of Regret among primary care physicians: a survey of diagnostic decisions
Müller, B. S., Donner-Banzhoff, N., Beyer, M., Haasenritter, J., Müller, A., & Seifart, C. (2020) · Figshare · doi:10.6084/m9.figshare.11998905
Staal, J., Alsma, J., Mamede, S., Olson, A. P. J., Prins-van Gilst, G., Geerlings, S. E., Plesac, M., Sundberg, M. A., Frens, M. A., Schmidt, H. G., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14462719
Self-citationStaal, J., Alsma, J., Mamede, S., Olson, A. P. J., Prins-van Gilst, G., Geerlings, S. E., Plesac, M., Sundberg, M. A., Frens, M. A., Schmidt, H. G., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14462716
Self-citationde Jesus, M. S., Cruz, J. V. A., Coelho, L. B., Borja, L. S., da Silva, E. D., Solcà, M. D. S., Brodskyn, C. I., & Fraga, D. B. M. (2021) · Figshare · doi:10.6084/m9.figshare.15161955
Kestel, S., Çelik, G. H. T., & Güney, T. (2025) · Global Nursing Insights · doi:10.31125/globnursinsights.1770091
The Contribution of Nursing–Laboratory Communication Quality to Reducing Diagnostic Delays
Alshammari, M. M., Alanazi, A. M. S., Alenezi, A. A. M., Alharbi, K. F. N., AlKhaldi, S. A. S., Alruwili, A. M. I., Aisamare, M. M. F. A., Alenezi, G. A. T., Hawswi, B. U. M., Alsubaie, Z. M. B., et al. (2024) · International Journal of Computational and Experimental Science and Engineering · doi:10.22399/ijcesen.4766
Diagnostic investigations: harmless tests or booby traps?
Elwyn, G. J., Zwaan, L., Hairwassers, D. A. E., & Han, P. K. J. (2026) · Diagnosis · doi:10.1515/dx-2025-0047
Self-citationSalisbury, L., Roggio, R., Fajardo, D. J., & Smith, J. J. (2026) · Science & Technology Libraries · doi:10.1080/0194262x.2026.2656747
Schols, L. A., Zwaan, L., Woltman, A. M., Scheepers, R. A., Haagsma, J. A., & Rood, P. P. M. (2026) · European Journal of Emergency Medicine · doi:10.1097/mej.0000000000001337
Self-citationSystematic review: diagnostic-related failure demand in different health conditions
Nykänen, N., Seppänen, M. R. J., Vartiainen, V. A., Ramste, M. O., & Sanmark, E. (2026) · Journal of Public Health · doi:10.1007/s10389-026-02790-4 · Cited by 1
An analysis of pediatric retinoblastoma medical malpractice litigation
Miller, V., Reese, A. D., Foote, K., Navarro, A., Galfano, A., & Hietanen, C. (2026) · PLoS ONE · doi:10.1371/journal.pone.0342114
Ackfeld, T., Guéchi, Y., Schwab, J. M., Castelain, T., Galofaro, L., Gay, C., Pugnale, S., Schmutz, T., Hautz, W. E., & Ribordy, V. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15187177
Bagley, R. (2026) · Frontiers in Veterinary Science · doi:10.3389/fvets.2026.1940970
Metadata
- 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 › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Keywords
- diagnostic errors, patient safety, underdiagnosis, retrospective diagnosis
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
