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.
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“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]
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“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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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
Cited by
Sorted by citations
The Global Burden of Diagnostic Errors in Primary Care
Singh, H., Schiff, G. D., Graber, M. L., Onakpoya, I., & Thompson, M. J. (2017) · BMJ Quality & Safety · doi:10.1136/bmjqs-2016-005401 · Cited by 395
Self-citationCognitive bias in clinical medicine
O'Sullivan, E., & Schofield, S. (2018) · Journal of the Royal College of Physicians of Edinburgh · doi:10.4997/jrcpe.2018.306 · Cited by 334
Defining and Measuring Diagnostic Uncertainty in Medicine: A Systematic Review
Bhise, V., Rajan, S. S., Sittig, D. F., Morgan, R. O., Chaudhary, P., & Singh, H. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4164-1 · Cited by 308
Self-citationMirbabaie, M., Stieglitz, S., & Frick, N. (2021) · Health and Technology · doi:10.1007/s12553-021-00555-5 · Cited by 283
Overdiagnosis in primary care: framing the problem and finding solutions
Kale, M., & Korenstein, D. R. (2018) · BMJ · doi:10.1136/bmj.k2820 · Cited by 176
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
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