Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors

The 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].”

• cites [4] Zwaan, 2015, The Challenges in Defining and Measuring Diagnostic Error, Diagnosis sourceSupported
• cites [1] Graber, 2012, Bringing Diagnosis into the Quality and Safety Equations, JAMA sourceNot checked — no full text of the source
• cites [5] Satterfield, K., Rubin, J.C., and Friedman, C.P. (2018). Toward a Learning Ecosystem for Diagnostic Excellence, University of Michigan Library.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Self-referred patients were found to experience 3.2 times more delay than those referred by their primary care providers.

“self-referred patients were found to experience 3.2 times more delay than those referred by their primary care providers (PCPs), as PCPs often play a crucial role in facilitating follow-up care and providing guidance and resources [50].”

• cites [50] Vang, 2022, Delays in Follow-up Care for Abnormal Mammograms in Mobile Mammography Versus Fixed-Clinic Patients, J. Gen. Intern. Med. sourceSupported

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].”

• cites [4] Zwaan, 2015, The Challenges in Defining and Measuring Diagnostic Error, Diagnosis sourcePartly supported

  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)

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• cites [6] Bhise, 2015, Measuring Diagnostic Safety of Inpatients: Time to Set Sail in Uncharted Waters, Diagnosis sourcePartly supported

  The main text (page not provided) says national inpatient safety efforts measure infections and adverse drug events but do not address diagnostic errors, partly because these errors are difficult to identify, define, and measure. It does not mention wrong-site surgery as a comparator, so that example is not supported by this source. (LLM, conf=0.84)

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• cites [7] Graber, 2005, Diagnostic Errors in Medicine: A Case of Neglect, Jt. Comm. J. Qual. Patient Saf. sourceNot checked — no full text of the source

Patients living in rural areas commonly have limited medical resources and staffing since advanced medical services and equipment are primarily found in urban areas or private facilities.

“Patients living in rural areas commonly have limited medical resources and staffing since advanced medical services and equipment are primarily found in urban areas or private facilities [40,41].”

• cites [40] Dianatinasab, 2016, Impact of Social and Clinical Factors on Diagnostic Delay of Breast Cancer: A Cross-Sectional Study, Medicine sourcePartly supported

  The Discussion says rural areas in Iran provide only basic care and that residents must travel to cities for specialized services such as mammography and pathology. It does not establish a shortage of rural medical staff, and the citing sentence presents the finding more generally than the paper’s Iranian breast-cancer context. (LLM, conf=0.85)

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• cites [41] Smith, 2019, Isolated, Small, and Large Hospitals Have Fewer Nursing Resources than Urban Hospitals: Implications for Rural Health Policy, Public Health Nurs. sourcePartly supported

  The Discussion reports fewer nurses and higher patient-to-RN ratios as hospitals become more rural, supporting the claim about limited staffing. The paper also describes limited healthcare access for rural populations, but it does not establish that advanced medical services or equipment are primarily found in urban areas or private facilities, or that this explains the staffing shortfall. (LLM, conf=0.88)

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Lack of nearby facilities can lead to longer delays compared with patients in urban areas, especially when facing rare diseases requiring specialized medical treatment and diagnosis.

“This lack of nearby facilities can lead to longer delays compared with patients in urban areas, especially when facing rare diseases requiring specialized medical treatment and diagnosis [44].”

• cites [44] Cohen, 2024, Genomic Answers for Kids: Toward More Equitable Access to Genomic Testing for Rare Diseases in Rural Populations, Am. J. Hum. Genet. sourceSupported

Greater diagnostic knowledge, including the ability to analyze clinical data, make accurate differential diagnoses, and use diagnostic tests effectively, is associated with fewer adverse outcomes among high-risk diagnostic error situations.

“Greater diagnostic knowledge, including the ability to analyze clinical data, make accurate differential diagnoses, and use diagnostic tests effectively, is associated with fewer adverse outcomes among high-risk diagnostic error situations [82].”

• cites [82] Bm, 2021, Association between Primary Care Physician Diagnostic Knowledge and Death, Hospitalisation and Emergency Department Visits Following an Outpatient Visit at Risk for Diagnostic Error: A Retrospective Cohort Study Using Medicare Claims, BMJ Open sourceSupported

Despite the wealth of information contained in medical records, socio-behavioral data are commonly excluded.

“Despite the wealth of information contained in medical records, socio-behavioral data are commonly excluded [22,23].”

• cites [22] Feller, 2020, Detecting Social and Behavioral Determinants of Health with Structured and Free-Text Clinical Data, Appl. Clin. Inform. sourceNot checked — no full text of the source
• cites [23] Goodday, 2020, Maximizing the Use of Social and Behavioural Information from Secondary Care Mental Health Electronic Health Records, J. Biomed. Inform. sourceSupported

In clinical settings, clinicians often tackle tasks using System 1 thinking, particularly in time-sensitive or high-pressure situations.

“In clinical settings, clinicians often tackle tasks using System 1 thinking, particularly in time-sensitive or high-pressure situations [91].”

• cites [91] Bate, 2012, How Clinical Decisions Are Made, Br. J. Clin. Pharmacol. sourceSupported

Patients labeled as drug seekers by clinicians in previous visits may hesitate to return to the hospital due to the fear of being mistreated and misunderstood.

“patients labeled as drug seekers by clinicians in previous visits may hesitate to return to the hospital due to the fear of being mistreated and misunderstood [66].”

• cites [66] Meyerson, 2021, I Don’t Even Want to Go to the Doctor When I Get Sick Now: Healthcare Experiences and Discrimination Reported by People Who Use Drugs, Arizona 2019, Int. J. Drug Policy sourceSupported

Barriers such as the patient's previous experience, mental health, and cultural and social background can hinder the development of trust and communication with clinicians during the diagnostic process.

“some barriers, such as the patient’s previous experience, mental health, and cultural and social background, can hinder the development of trust and communication with clinicians during the diagnostic process [63].”

• cites [63] Kwame, A., and Petrucka, P.M. (2021). A Literature-Based Study of Patient-Centered Care and Communication in Nurse-Patient Interactions: Barriers, Facilitators, and the Way Forward. BMC Nurs., 20. sourcePartly supported

  The ‘Personal and Behaviour Related Barriers’ section (page unavailable) says past experiences and cultural backgrounds can affect nurse–patient communication. It does not establish mental health as one of these barriers or specifically connect the listed factors to trust and communication during the diagnostic process. (LLM, conf=0.85)

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Some patients demand specific testing methods or treatments due to their cultural considerations that are in conflict with current guidance from their healthcare providers.

“some patients demand specific testing methods or treatments due to their cultural considerations that are in conflict with current guidance from their healthcare providers [73].”

• cites [73] Piccardi, 2018, Social Disparities in Patient Safety in Primary Care: A Systematic Review, Int. J. Equity Health sourcePartly supported

  The Discussion (page unavailable) suggests that patients’ culture and assertiveness could lead them to demand inappropriate prescriptions or testing. The citing sentence presents this possible explanation as an established behavior and adds a conflict with providers’ current guidance that the review does not explicitly describe. (LLM, conf=0.88)

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Adherence to assessments that involve invasive examinations or procedures, or unfamiliar treatment settings, can be impaired by various mental conditions.

“adherence to assessments that involve invasive examinations or procedures, such as blood draws and injections, or unfamiliar treatment settings, can be impaired by various mental conditions [69].”

• cites [69] Shefer, G., Henderson, C., Howard, L.M., Murray, J., and Thornicroft, G. (2014). Diagnostic Overshadowing and Other Challenges Involved in the Diagnostic Process of Patients with Mental Illness Who Present in Emergency Departments with Physical Symptoms—A Qualitative Study. PLoS ONE, 9. sourcePartly supported

  In Results, “Difficulties in communication and challenging behaviour” (page unavailable), the paper reports that some patients with mental illness refused examinations and needle-related procedures such as phlebotomy. “The crowded nature of the ED environment” says a noisy, chaotic emergency department can exacerbate symptoms and make treatment harder, but it does not identify unfamiliarity with a treatment setting as the reason for impaired adherence. (LLM, conf=0.82)

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Diagnostic error research has primarily focused on capturing disease-related factors, including laboratory results, imaging, and treatments, which are easier to extract from medical records.

“Diagnostic error research has primarily focused on capturing disease-related factors [18,19,20,21], including laboratory results, imaging, and treatments, which are easier to extract from medical records.”

• cites [18] Singh, 2012, Electronic Health Record-Based Surveillance of Diagnostic Errors in Primary Care, BMJ Qual. Saf. sourceCould not verify

  The Background and Discussion passages describe diagnostic errors as understudied and compare methods for detecting them; they do not say research has primarily focused on disease-related factors. The Methods mention chest X-rays as diagnostic evidence, but neither those passages nor further searches for laboratory results, imaging, treatments, and extraction from records establish the claimed research focus or explain that those factors are easier to extract. Page numbers were not available in our copy. (LLM, conf=0.72)

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• cites [19] Franco, 2017, Diagnostic Delays and Errors in Head and Neck Cancer Patients: Opportunities for Improvement, Am. J. Med. Qual. sourceNot checked — no full text of the source
• cites [20] Brondino, 2022, Missed Diagnoses and Misdiagnoses of Adults with Autism Spectrum Disorder, Eur. Arch. Psychiatry Clin. Neurosci. sourceCould not verify

  The Procedures section describes a retrospective review of clinical charts for adults diagnosed with ASD, while the Discussion addresses difficulties in psychiatric assessment. Neither addresses whether diagnostic-error research primarily captures disease-related factors or whether laboratory results, imaging, and treatments are easier to extract from medical records. Searches for those terms and for the proposed research focus found no supporting passage; page numbers were unavailable. (LLM, conf=0.78)

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• cites [21] Triplett, 2022, Diagnosis, Differential Diagnosis and Misdiagnosis of Susac Syndrome, Eur. J. Neurol. sourcePartly supported

  The Methods describe a retrospective review of medical records, and the Results report MRI findings, diagnostic tests, and treatments in patients with Susac syndrome (page unavailable). This supports the paper as an example of research capturing disease-related factors, but it does not say that diagnostic error research primarily focuses on those factors or that they are easier to extract from records. (LLM, conf=0.82)

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This fragmentation makes it challenging to understand how clinical, organizational, technological, and environmental factors collectively shape the complete picture of diagnosis.

“This fragmentation makes it challenging to understand how clinical, organizational, technological, and environmental factors collectively shape the complete picture of diagnosis [34].”

• cites [34] Ladell, 2025, The Problem with How We View Medical (and Diagnostic) Error in Emergency Medicine, Acad. Emerg. Med. sourceSupported

System 1 thinking can lead to judgment errors and cognitive biases, such as anchoring, confirmation, attribution, availability, confidence, and delay discounting.

“it can also lead to judgment errors and cognitive biases [92,93], such as anchoring, confirmation, attribution, availability, confidence, and delay discounting.”

• cites [92] Norman, 2014, The Etiology of Diagnostic Errors: A Controlled Trial of System 1 Versus System 2 Reasoning, Acad. Med. sourceNot checked — no full text of the source
• cites [93] Gojanovic, 2022, Cognitive Biases Cloud Our Clinical Decisions and Patient Expectations: A Narrative Review to Help Bridge the Gap between Evidence-Based and Personalized Medicine, Ann. Phys. Rehabil. Med. sourcePartly supported

  Section 4 links cognitive biases to System 1 thinking, and the paper discusses anchoring, confirmation, availability, overconfidence, and a short-term preference it calls hyperbolic discounting. Our copy does not identify attribution bias as such, so it does not fully support the cited list. (LLM, conf=0.82)

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Clinicians' decision making in complex cases mirrors delay discounting, as they balance their perceived best benefits with the relative utility of possible health outcomes to effectively weigh risks and benefits.

“Clinicians’ decision making in complex cases mirrors delay discounting, as they balance their perceived best benefits with the relative utility of possible health outcomes to effectively weigh risks and benefits [111].”

• cites [111] Theodossi, 1984, Doctors’ Attitudes to Risk in Difficult Clinical Decisions: Application of Decision Analysis in Hepatobiliary Disease, Br. Med. J. (Clin. Res. Ed.) sourcePartly supported

  The Introduction describes difficult clinical decisions as weighing the likelihood of intervention succeeding against the relative merits of possible health outcomes. The Calculation of Utilities section formalizes that comparison using probabilities and utilities. The paper does not characterize this process as delay discounting, so that part of the claim is unsupported. (LLM, conf=0.85)

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Inconsistent recommendations primarily originate from connections with unclear underlying evidence.

“The inconsistent recommendations primarily originate from connections with unclear underlying evidence [146,157].”

• cites [146] Mikati, 2023, Testing Guidelines during Times of Crisis: Challenges and Limitations of Developing Rapid and Living Guidelines, Clin. Microbiol. Infect. sourcePartly supported

  The ‘Challenge of rapidly changing evidence’ section says the evidence did not clearly distinguish differences in prevalence and pretest probability, and that these differences guided varying recommendations. The Conclusions also discuss recommendations based on low-certainty evidence. Neither passage says that inconsistent recommendations primarily originate from unclear connections to underlying evidence. (LLM, conf=0.78)

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• cites [157] Dagens, 2020, Scope, Quality, and Inclusivity of Clinical Guidelines Produced Early in the COVID-19 Pandemic: Rapid Review, BMJ sourcePartly supported

  The Discussion (‘Variation in recommendations’; page not supplied) reports that recommendations varied and that unclear links to underlying evidence made the reasoning behind them hard to ascertain. It does not say those unclear links were the primary cause of the inconsistency; it says complex factors were involved. (LLM, conf=0.86)

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Overlapping findings in ALS and other neuromuscular disorders assessed through EMG still need further testing and the engagement of a multidisciplinary team for interpretation to ensure an accurate diagnosis.

“research shows that overlapping findings in amyotrophic lateral sclerosis (ALS) and other neuromuscular disorders assessed through electromyography (EMG) still need further testing and the engagement of a multidisciplinary team for interpretation to ensure an accurate diagnosis [52].”

• cites [52] Richards, 2020, Time to Diagnosis and Factors Affecting Diagnostic Delay in Amyotrophic Lateral Sclerosis, J. Neurol. Sci. sourcePartly supported

  Section 7 (page unavailable) says EMG does not guarantee a correct diagnosis, that other neuromuscular diseases can be difficult to distinguish from ALS, and that an experienced electrophysiologist should interpret the findings. Sections 9 and 12 discuss multidisciplinary ALS care and specialist evaluation, but do not say a multidisciplinary team is needed to interpret EMG; section 12 also cautions against unnecessary additional testing. (LLM, conf=0.86)

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Most clinical practice guidelines target specific diseases, ignoring their relevance for patients with various comorbidities.

“In addition to the aforementioned issues with diagnostic error definitions, most clinical practice guidelines target specific diseases, ignoring their relevance for patients with various comorbidities [148,149,150].”

• cites [148] Kerr, 2007, Beyond Comorbidity Counts: How Do Comorbidity Type and Severity Influence Diabetes Patients’ Treatment Priorities and Self-Management?, J. Gen. Intern. Med. sourcePartly supported

  The introductory passage labeled Abstract says that most diabetes disease-management programs and guidelines focus on diabetes and do not address the challenges of managing concomitant conditions. It does not establish the broader claim about most clinical practice guidelines across diseases. (LLM, conf=0.86)

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• cites [149] Uhlig, 2014, A Framework for Crafting Clinical Practice Guidelines That Are Relevant to the Care and Management of People with Multimorbidity, J. Gen. Intern. Med. sourceSupported
• cites [150] Maciejewski, 2014, Approaches to Comparative Effectiveness Research in Multimorbid Populations, Med. Care sourceNot checked — no full text of the source

Such biases prevent clinicians from exploring more information and considering alternative diagnoses, leading to incomplete or insufficient assessments.

“Such biases prevent clinicians from exploring more information and considering alternative diagnoses, leading to incomplete or insufficient assessments [94].”

• cites [94] Webster, 2021, Cognitive Biases in Diagnosis and Decision Making during Anaesthesia and Intensive Care, BJA Educ. sourceSupported

When diagnosing older patients, symptoms such as heart failure may only be attributed to being old rather than other possible reasons.

“when diagnosing older patients, symptoms such as heart failure may only be attributed to being old rather than other possible reasons [54].”

• cites [54] Kwok, 2022, Missed Opportunities in the Diagnosis of Heart Failure: Evaluation of Pathways to Determine Sources of Delay to Specialist Evaluation, Curr. Heart Fail. Rep. sourceSupported

CAP guidelines did not provide clear benchmarks for timeliness.

“However, clear benchmarks for timeliness were not provided.”

• cites [147] Nakhleh, 2015, Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology, Arch. Pathol. Lab. Med. sourceSupported

Vitamin D screening is often ordered for patients with general symptoms like fatigue or vague pain rather than those who are actually at risk.

“However, it is often ordered for patients with general symptoms like fatigue or vague pain, rather than those who are actually at risk.”

• cites [138] Rockwell, 2020, Patterns of Clinical Care Subsequent to Nonindicated Vitamin D Testing in Primary Care, J. Am. Board. Fam. Med. sourceSupported

Clinicians often sacrifice the time spent with patients to commit to the required administrative duties.

“clinicians often sacrifice the time spent with patients to commit to the required administrative duties [29,113,114].”

• cites [29] Rao, 2017, The Impact of Administrative Burden on Academic Physicians: Results of a Hospital-Wide Physician Survey, Acad. Med. sourceNot checked — no full text of the source
• cites [113] Heuer, 2022, More Evidence That the Healthcare Administrative Burden Is Real, Widespread and Has Serious Consequences Comment on Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study, Int. J. Health Policy Manag. sourceSupported
• cites [114] Dugdale, 1999, Time and the Patient–Physician Relationship, J. Gen. Intern. Med. sourceSupported

Clinicians exhibit anchoring bias by placing excessive weight on initial information or salient symptom features, focusing on confirming their initial assumption and concluding the diagnosis without thoroughly investigating other alternative possibilities.

“Clinicians exihit this bias by placing excessive weight on the initial information they receive or salient symptom features a patient presents, focusing on confirming their initial assumption during the diagnostic process and concluding the diagnosis without thoroughly investigating other alternative possibilities [97,98].”

• cites [97] Busby, 2018, Bias in Radiology: The How and Why of Misses and Misinterpretations, Radiographics sourcePartly supported

  The Introduction’s “Anchoring Bias” section says early information is inappropriately weighted and an initial diagnostic impression can persist despite contrary information. But the paper describes seeking confirmatory evidence and accepting an initial diagnosis as final under separate headings, “Confirmation Bias” and “Premature Closure.” It does not present the entire sequence, or emphasis on salient symptom features, as anchoring bias alone. (LLM, conf=0.85)

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• cites [98] Florman, 2020, A Primer on Cognitive Errors Illustrated Through the Lens of a Neurosurgical Practice, J. Maine Med. Cent. sourceSupported

Clinicians face considerable difficulties identifying and differentiating between similar conditions, especially when symptoms frequently appear across many common diseases.

“Clinicians face considerable difficulties identifying and differentiating between similar conditions, especially when symptoms frequently appear across many common diseases [124,125].”

• cites [124] Hussain, 2020, Similarities Between Depression and Neurodegenerative Diseases: Pathophysiology, Challenges in Diagnosis and Treatment Options, Cureus sourcePartly supported

  The Introduction and background says that overlapping symptoms make differential diagnosis challenging for depression and neurodegenerative diseases. The claim extends this difficulty to symptoms appearing across many common diseases, a broader scope the paper does not establish. (LLM, conf=0.84)

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• cites [125] Karantzoulis, 2011, Distinguishing Alzheimer’s Disease from Other Major Forms of Dementia, Expert Rev. Neurother. sourcePartly supported

  The section “Distinguishing AD dementia from other major forms of dementia” says that overlapping clinical presentations make diagnosis challenging and that other dementia syndromes can mimic Alzheimer’s disease. The Expert commentary likewise describes substantial overlap between dementia syndromes. The source supports the point for dementias, but not the claim’s broader reference to many common diseases. (LLM, conf=0.82)

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Delay discounting bias is often exacerbated by sludge or the frictions or administrative burdens that make it difficult for people to achieve what they want or need.

“This bias is often exacerbated by “sludge” or the frictions or administrative burdens that make it difficult for people to achieve what they want or need [28,112].”

• cites [28] Rockwell, 2023, A “Sludge Audit” for Health System Colorectal Cancer Screening Services, Am. J. Manag. Care sourcePartly supported

  The Take-Away Points define sludge as frictions or administrative burdens that make it difficult for people to attain what they want or need. The Discussion says sludge may influence decision-making and deter colorectal cancer screening, but the paper does not establish that it often exacerbates delay discounting bias. Page numbers are unavailable in our copy. (LLM, conf=0.87)

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• cites [112] Epling, 2023, “Sludge Audit” to Identify Barriers to Colorectal Cancer Screening, Ann. Fam. Med. sourcePartly supported

  The Abstract defines sludge as excessive frictions, including paperwork burdens, that can deprive people of access to services; its conclusion says sludge appears to impede colorectal cancer screening. It does not address delay discounting or say that sludge exacerbates that bias. (LLM, conf=0.85)

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When there are recent or notable cases, clinicians tend to make a diagnosis based on these events, often overlooking other factors that may be more relevant or more closely aligned with the patient's symptoms.

“when there are recent or notable cases, clinicians tend to make a diagnosis based on these events, often overlooking other factors that may be more relevant or more closely aligned with the patient’s symptoms [102].”

• cites [102] Li, 2020, Availability Bias Causes Misdiagnoses by Physicians: Direct Evidence from a Randomized Controlled Trial, Intern. Med. sourceSupported

Symptoms such as dyspnea and wheezing, which are commonly linked to COPD, can also occur in other conditions like CHF, asthma, lung cancer, pneumonia, and interstitial lung diseases.

“Symptoms such as dyspnea and wheezing, which are commonly linked to chronic obstructive pulmonary disease (COPD), can also occur in other conditions like congestive heart failure (CHF), asthma, lung cancer, pneumonia, and interstitial lung diseases [126,127].”

• cites [126] Moua, 2008, COPD and PE: A Clinical Dilemma, Int. J. Chron. Obs. Pulmon Dis. sourcePartly supported

  The Physical exam section identifies dyspnea and wheezing as features of COPD. The Introduction and Chest X-ray sections discuss dyspnea in heart failure, pneumonia, and asthma, but the cited paper does not establish that wheezing occurs in those conditions or address lung cancer and interstitial lung diseases as alternatives. (LLM, conf=0.87)

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• cites [127] Pellicori, 2020, Chronic Obstructive Pulmonary Disease and Heart Failure: A Breathless Conspiracy, Heart Fail. Clin. sourcePartly supported

  The Introduction and Synopsis state that breathlessness (dyspnea) is common to COPD and heart failure, supporting that part of the claim. The passages do not establish that wheezing occurs across the listed conditions or identify asthma, lung cancer, pneumonia, and interstitial lung diseases as alternatives; searches for those terms found no supporting passage. Page numbers were not available in our copy. (LLM, conf=0.87)

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The wide range of symptoms and behaviors, accompanied by different severity and combination levels, complicates diagnosis.

“The wide range of symptoms and behaviors, accompanied by different severity and combination levels, complicates diagnosis [131,132].”

• cites [131] Westen, 2012, Prototype Diagnosis of Psychiatric Syndromes, World Psychiatry sourceSupported
• cites [132] Bidari, 2018, Challenges in Fibromyalgia Diagnosis: From Meaning of Symptoms to Fibromyalgia Labeling, Korean J. Pain sourceSupported

Overlapping symptoms associated with various diseases are a major contributor to diagnostic errors.

“Overlapping symptoms associated with various diseases are a major contributor to diagnostic errors [122,123].”

• cites [122] Gwathmey, 2023, Diagnostic Delay in Amyotrophic Lateral Sclerosis, Eur. J. Neurol. sourcePartly supported

  The Discussion/Future Directions section says people with ALS are often misdiagnosed with conditions that mimic it and identifies overlapping clinical presentations. This supports the point for ALS, but the paper does not establish that symptom overlap is a major contributor to diagnostic errors across diseases generally. (LLM, conf=0.85)

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• cites [123] Rozenbaum, 2021, Estimating the Health Benefits of Timely Diagnosis and Treatment of Transthyretin Amyloid Cardiomyopathy, J. Comp. Eff. Res. sourceNot checked — no full text of the source

The variety of characteristics seen in different diseases adds a layer of complexity to the diagnostic process.

“the variety of characteristics seen in different diseases adds a layer of complexity to the diagnostic process [129,130].”

• cites [129] Chang, 2011, Diagnostic Challenges in Retinitis Pigmentosa: Genotypic Multiplicity and Phenotypic Variability, Curr. Genom. sourcePartly supported

  The Introduction says that RP has a vast differential diagnosis and that its broad range of clinical severity makes diagnosis challenging. This supports the point for retinitis pigmentosa, but the cited paper does not establish the broader claim across different diseases generally. (LLM, conf=0.82)

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• cites [130] Yu, 2015, Precision Medicine for Continuing Phenotype Expansion of Human Genetic Diseases, Biomed Res. Int. sourceSupported

Applying specific diagnostic tests to the general population with constitutional symptoms can result in low-value outcomes.

“Furthermore, applying specific diagnostic tests to the general population with constitutional symptoms can result in low-value outcomes.”

• cites [138] Rockwell, 2020, Patterns of Clinical Care Subsequent to Nonindicated Vitamin D Testing in Primary Care, J. Am. Board. Fam. Med. sourcePartly supported

  The Patterns of Care section reports that some services following nonindicated vitamin D tests were themselves low value; fatigue was a common diagnosis associated with those tests. This supports the concern about testing patients with nonspecific symptoms, but the study examined vitamin D testing in primary care, not specific diagnostic tests generally or the general population. (LLM, conf=0.85)

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Availability issues, such as geographical constraints, resource shortages, or long waiting times, can cause significant diagnostic errors even when specific tests exist.

“Second, availability issues, such as geographical constraints, resource shortages, or long waiting times, can cause significant diagnostic errors even when specific tests exist [189,190].”

• cites [189] McNerney, 2012, Tuberculosis Diagnostics and Biomarkers: Needs, Challenges, Recent Advances, and Opportunities, J. Infect. Dis. sourcePartly supported

  In “The Need for More Accurate and Rapid Diagnostics” (page not provided), the paper says that tests can be beyond patients’ reach and that limited facilities and diagnostic delays leave tuberculosis cases undetected. “Dilemmas and Priorities for the Future” also describes access problems when services are centralized. These passages support the availability concern, but do not specifically establish that it causes significant diagnostic errors, as opposed to delays or missed diagnoses. (LLM, conf=0.84)

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• cites [190] McNerney, 2015, Diagnostics for Developing Countries, Diagnostics sourcePartly supported

  The Introduction (page unavailable) says laboratories may be geographically inaccessible and under-resourced, and that particular tests may not reach much of the population. Section 3.1 (page unavailable) adds that a community-based rapid test may detect more cases than a more sensitive test confined to a specialized laboratory. These passages support missed diagnoses despite the existence of tests, but do not establish long waiting times or quantify the errors as significant. (LLM, conf=0.83)

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By integrating and analyzing patient symptoms, medical history, test results, and other risk factors, CDSS have the capability to support disease detection and identification.

“By integrating and analyzing patient symptoms, medical history, test results, and other risk factors, CDSS have the capability to support disease detection and identification [214,215], such as the subtle or ambiguous patterns that clinicians often overlook [216,217].”

• cites [214] Gong, 2023, Deep Learning-Based Clinical Decision Support System for Gastric Neoplasms in Real-Time Endoscopy: Development and Validation Study, Endoscopy sourceNot checked — no full text of the source
• cites [215] Masood, A., Naseem, U., Rashid, J., Kim, J., and Razzak, I. (2024). Review on Enhancing Clinical Decision Support System Using Machine Learning. CAAI Trans. Intell. Technol. sourceSupported
• cites [216] Ali, 2023, CDSS for Early Recognition of Respiratory Diseases Based on AI Techniques: A Systematic Review, Wirel. Pers. Commun. sourceNot checked — no full text of the source
• cites [217] Choi, 2020, Artificial Intelligence for the Diagnosis of Heart Failure, npj Digit. Med. sourceSupported

Anemia is named differently across EHR systems; one might call it post-hemorrhagic anemia, while another refers to it as blood loss anemia.

“For example, anemia is named differently across systems; one might call it “post-hemorrhagic anemia”, while another refers to it as “blood loss anemia”.”

• cites [170] Fu, 2022, Assessment of Data Quality Variability across Two EHR Systems through a Case Study of Post-Surgical Complications, AMIA Summits Transl. Sci. Proc. sourcePartly supported

  The Results (page unavailable) report that anemia expressions vary between Epic and Centricity. But the paper gives “Anemia Posthemorrhagic Acute (Blood Loss Anemia)” as one expression; it does not say one system uses “post-hemorrhagic anemia” while the other uses “blood loss anemia.” (LLM, conf=0.86)

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The copy-paste function in EHRs allows clinicians to reuse existing medical notes without carefully reviewing them again.

“Another contributing factor to missing data is the “copy-paste” function in EHRs, which allows clinicians to reuse existing medical notes without carefully reviewing them again [180,181].”

• cites [180] Tsou, 2017, Safe Practices for Copy and Paste in the EHR, Appl. Clin. Inform. sourcePartly supported

  The Introduction says copy and paste lets clinicians insert existing information into EHR notes. The Description warns that failure to curate copied text can leave outdated or inconsistent information, and the safe-practice recommendations call for verification before submission. These passages support the risk of reuse without careful review, but do not establish the citing sentence’s broader claim that copy and paste contributes to missing data. (LLM, conf=0.82)

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• cites [181] Wang, 2023, An Evaluation of Copy and Paste Events in Electronic Notes of Patients with Hospital Acquired Conditions, Int. J. Med. Inform. sourceNot checked — no full text of the source

Many EHR systems only use proprietary vocabularies that lack compatibility.

“This challenge is especially common since many systems only use proprietary vocabularies that lack compatibility [173].”

• cites [173] Gettinger, 2012, Transitioning from a Legacy EHR to a Commercial, Vendor-Supplied, EHR: One Academic Health System’s Experience, Appl. Clin. Inform. sourcePartly supported

  The Background section says that data exchange between EHR systems remains a major challenge, and §3.4 describes difficulties mapping some medication entries during a transition. The paper does not say that many systems use only proprietary vocabularies or identify those vocabularies as the reason for incompatibility; in this case, both systems used the same drug database. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Some CDSS can generate ranked lists of potential diagnoses for disease differentiation, including disease subtype classification or stages, to guide subsequent treatment planning.

“Some CDSS can further generate ranked lists of potential diagnoses for disease differentiation [219,220,221], including disease subtype classification or stages, to guide subsequent treatment planning [222].”

• cites [219] Tao, 2020, Accuracy and Effects of Clinical Decision Support Systems Integrated with BMJ Best Practice–Aided Diagnosis: Interrupted Time Series Study, JMIR Med. Inform. sourceSupported
• cites [220] Harada, T., Miyagami, T., Kunitomo, K., and Shimizu, T. (2021). Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review. Int. J. Environ. Res. Public Health, 18. sourceSupported
• cites [221] Yanagita, Y., Shikino, K., Ishizuka, K., Uchida, S., Li, Y., Yokokawa, D., Tsukamoto, T., Noda, K., Uehara, T., and Ikusaka, M. (2023). Improving Diagnostic Accuracy Using a Clinical Diagnostic Support System for Medical Students during History-Taking: A Randomized Clinical Trial. BMC Med. Educ., 23. sourceSupported
• cites [222] Gong, 2023, Clinical Decision Support System for All Stages of Gastric Carcinogenesis in Real-Time Endoscopy: Model Establishment and Validation Study, J. Med. Internet Res. sourcePartly supported

  The Discussion (Principal Findings; page not provided) says the CDSS classifies stages of gastric carcinogenesis, and the Methods (Development of the CDSS; page not provided) describes its six diagnostic classes. Those passages support the stage-classification part attributed to this source, but do not say that its classifications guide subsequent treatment planning. The ranked-list portion of the sentence is attached to other citations. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

ROC curves use the average performance across all thresholds, including those not used in clinical practice, which can limit their clinical relevance.

“However, since ROC curves use the average performance across all thresholds, including those not used in clinical practice, this can limit their clinical relevance.”

• cites [198] 2011, Diagnostic Accuracy and Receiver-Operating Characteristics Curve Analysis in Surgical Research and Decision Making, Ann. Surg. sourceNot checked — no full text of the source
• cites [199] Halligan, 2015, Disadvantages of Using the Area under the Receiver Operating Characteristic Curve to Assess Imaging Tests: A Discussion and Proposal for an Alternative Approach, Eur. Radiol. sourceSupported

A key challenge in EHR systems is their contextual variability, with significant differences in documentation styles and data structures across institutions that impact the types of information recorded.

“A key challenge in EHR systems is their contextual variability, with significant differences in documentation styles and data structures across institutions that impact the types of information recorded [169].”

• cites [169] Fu, S., Vassilaki, M., Ibrahim, O.A., Petersen, R.C., Pagali, S., St Sauver, J., Moon, S., Wang, L., Fan, J.W., and Liu, H. (2022). Quality Assessment of Functional Status Documentation in EHRs across Different Healthcare Institutions. Front. Digit. Health, 4. sourceSupported

71.5% of medical errors arise from missing information about patient symptoms or medical history details.

“However, 71.5% of medical errors arise from missing information about patient symptoms or medical history details [177].”

• cites [177] Weiner, 2020, How Accurate Is the Medical Record? A Comparison of the Physician’s Note with a Concealed Audio Recording in Unannounced Standardized Patient Encounters, J. Am. Med. Inform. Assoc. sourcePartly supported

  The Results report that 71.5% of 636 medical-record documentation errors were omissions. The claim broadens this to medical errors generally and says the missing information concerned symptoms or medical history; the Results say only that nearly half of all errors occurred in the history-of-present-illness and family/social-history sections. Page numbers are not available in the supplied passages. (LLM, conf=0.89)

  Experimental — accuracy not yet measured

EHRs potentially contribute to over 60% of diagnostic errors in ambulatory settings.

“However, EHRs potentially contribute to over 60% of diagnostic errors in ambulatory settings [165].”

• cites [165] Krevat, 2023, Identifying Electronic Health Record Contributions to Diagnostic Error in Ambulatory Settings Through Legal Claims Analysis, JAMA Netw. Open sourcePartly supported

  The Results report 122 ambulatory legal claims in which an EHR was a potential contributor to diagnostic error. They do not establish that EHRs contribute to over 60% of ambulatory diagnostic errors; the Methods describe a selected set of claims already coded with diagnosis-related and EHR-related factors, not all ambulatory diagnostic errors. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

There is a lack of appropriate or specific diagnostic tests for certain conditions or diseases, especially in their early stages.

“First, there is a lack of appropriate or specific diagnostic tests for certain conditions or diseases, especially in their early stages [185,186,187].”

• cites [185] Crosby, 2022, Early Detection of Cancer, Science sourceNot checked — no full text of the source
• cites [186] Gasparri, R., Guaglio, A., and Spaggiari, L. (2022). Early Diagnosis of Lung Cancer: The Urgent Need of a Clinical Test. J. Clin. Med., 11. sourceSupported
• cites [187] Wang, 2020, Advances in the Early Diagnosis of Hepatocellular Carcinoma, Genes Dis. sourceSupported

Device limitations can challenge the accuracy and effectiveness of a self-examination.

“Device limitations can challenge the accuracy and effectiveness of a self-examination [245].”

• cites [245] Wagner, 2023, Assessment of Pediatric Telemedicine Using Remote Physical Examinations with a Mobile Medical Device: A Nonrandomized Controlled Trial, JAMA Netw. Open sourcePartly supported

  The Discussion reports that amplified environmental or patient sounds sometimes prevented satisfactory auscultation, supporting the point that device-related limitations can affect examination quality. But the Methods describe examinations performed by a pediatric resident under a remote pediatrician’s guidance, not self-examinations; the source does not establish the claim for self-examination. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

In inpatient multidisciplinary healthcare teams, excluding direct care nurses and assistants from the core decision making team can lead to alienation.

“In inpatient multidisciplinary healthcare teams, excluding direct care nurses and assistants from the core decision making team can lead to alienation.”

• cites [252] Kreindler, 2012, Silos and Social Identity: The Social Identity Approach as a Framework for Understanding and Overcoming Divisions in Health Care, Milbank Q. sourceSupported

Junior clinicians may hesitate to report patient safety issues to avoid conflict with their senior leaders, fearing this can jeopardize their future careers.

“Junior clinicians may hesitate to report patient safety issues to avoid conflict with their senior leaders, fearing this can jeopardize their future careers.”

• cites [31] Clapper, 2018, TeamSTEPPS® Is an Effective Tool to Level the Hierarchy in Healthcare Communication by Empowering All Stakeholders, J. Commun. Healthc. sourcePartly supported

  In the main text (page unavailable), Clapper says juniors may stay silent about a senior’s mistake because they fear negative repercussions, and that fear of retribution can prevent workers from raising safety concerns. The paper does not specify that they fear jeopardizing their future careers. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Other observed challenges in various CDSS include static and non-updatable knowledge bases, which restrict the systems' ability to provide the most current and relevant care.

“Other observed challenges in various CDSS include static and non-updatable knowledge bases, which restrict the systems’ ability to provide the most current and relevant care [232].”

• cites [232] Nurek, 2015, Reducing Diagnostic Errors in Primary Care. A Systematic Meta-Review of Computerized Diagnostic Decision Support Systems by the LINNEAUS Collaboration on Patient Safety in Primary Care, Eur. J. Gen. Pract. sourcePartly supported

  The Results section (Sample characteristics; page not provided) identifies sustainability and upgradeability as requirements and says diagnostic decision-support ontologies need work to add new problems. It does not establish that various existing CDSS have static, non-updatable knowledge bases or show that this restricts their ability to provide current care. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Due to the fear of medical liability, some radiologists may select defensive behaviors that conclude the ambiguous image finding is abnormal.

“For example, due to the fear of medical liability, some radiologists may select defensive behaviors that conclude the ambiguous image finding is abnormal [265].”

• cites [265] Cho, 2018, Diagnosis of Cerebral Aneurysm Via Magnetic Resonance Angiography Screening: Emphasis on Legal Responsibility Increases False Positive Rate, Neurointervention sourceSupported

Before an accurate diagnosis is made for IgG4-RD, unnecessary surgeries or treatments are usually conducted due to multiple referrals for misdiagnosed conditions.

“Before an accurate diagnosis is made, unnecessary surgeries or treatments are usually conducted due to multiple referrals for misdiagnosed conditions [274].”

• cites [274] Goodchild, 2020, Experience from the First UK Inter-Regional Specialist Multidisciplinary Meeting in the Diagnosis and Management of IgG4-Related Disease, Clin. Med. sourcePartly supported

  The Introduction says misdiagnosis can lead to unnecessary surgery or delayed treatment, and the Discussion reports two patients treated for presumed cancer before IgG4-RD was diagnosed. The Referral pathway says patients had seen an average of four specialists, but the paper does not say unnecessary procedures or treatments usually occurred, or that multiple referrals caused them. Page numbers are unavailable in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

When a patient's condition presents with ambiguous or overlapping symptoms, which can be difficult to distinguish from one another, this may lead to consultations with different specialists and referrals to arrive at a final diagnosis.

“When a patient’s condition presents with ambiguous or overlapping symptoms, which can be difficult to distinguish from one another, this may lead to consultations with different specialists and referrals to arrive at a final diagnosis [272,273].”

• cites [272] Wells, 2019, Multidisciplinary Evaluation in Patients with Lung Disease Associated with Connective Tissue Disease, Semin. Respir. Crit. Care Med. sourcePartly supported

  The section “Diagnosis of CTD-ILD: The Role of MDD” says that uncertain diagnoses benefit from discussion among ILD physicians, CT radiologists, and rheumatologists. This supports the role of multiple specialists when a diagnosis is difficult, but the paper addresses CTD-associated lung disease specifically; it does not describe a general pattern of patients receiving referrals and separate consultations before a final diagnosis. Page numbers were not available in our copy. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [273] Wells, M., Alawi, S., Thin, K.Y.M., Gunawardena, H., Brown, A.R., Edey, A., Pauling, J.D., Barratt, S.L., and Adamali, H.I. (2022). A Multidisciplinary Approach to the Diagnosis of Antisynthetase Syndrome. Front. Med., 9. sourcePartly supported

  The Multidisciplinary team assessment section says antisynthetase syndrome may first be assessed in respiratory, rheumatology, neurology, or dermatology clinics, and that suspected cases should be referred to a multidisciplinary team for diagnosis. The Pulmonary disease section also notes that overlap with another lung disease can contribute to missed or delayed diagnosis. This supports the pathway described for antisynthetase syndrome, but not the claim as a general account of patients with ambiguous symptoms. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Due to the fear of undermining professional relationships, specialists frequently do not report diagnostic errors.

“Moreover, due to the fear of undermining professional relationships, specialists frequently do not report diagnostic errors.”

• cites [254] Bell, 2017, Transparency When Things Go Wrong: Physician Attitudes About Reporting Medical Errors to Patients, Peers, and Institutions, J. Patient Saf. sourcePartly supported

  The introductory passage under Abstract says clinicians report only a small minority of errors to institutions, and a later Abstract passage says fear of professional repercussions may impede reporting. The paper does not establish that specialists frequently fail to report diagnostic errors specifically, or that fear of undermining professional relationships is the cause. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [255] Kale, 2017, Peers without Fears? Barriers to Effective Communication among Primary Care Physicians and Oncologists about Diagnostic Delays in Cancer, BMJ Qual. Saf. sourcePartly supported

  The Results section (“Fears about giving and receiving feedback”; page not provided) says specialists feared jeopardising professional relationships, and one specialist said they had never given referring physicians negative feedback about a possible diagnostic delay or error. The paper describes reluctance to communicate about delays, but does not establish that specialists frequently fail to report diagnostic errors. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Pressure from social norms and shaming can inhibit clinicians from reporting or discussing clinical errors, as it may result in judgments about their competency and damage their reputation.

“Pressure from social norms and shaming can inhibit clinicians from reporting or discussing clinical errors, as it may result in judgments about their competency and damage their reputation [32,253].”

• cites [32] Grubenhoff, 2020, Pediatric Clinician Comfort Discussing Diagnostic Errors for Improving Patient Safety: A Survey, Pediatr. Qual. Saf. sourceSupported
• cites [253] Waring, 2005, Beyond Blame: Cultural Barriers to Medical Incident Reporting, Soc. Sci. Med. sourceNot checked — no full text of the source

Patients with head-and-neck cancer may also need to consult with various specialists due to the symptoms resembling benign conditions.

“Patients with head-and-neck cancer may also need to consult with various specialists due to the symptoms resembling benign conditions.”

• cites [275] Kassirian, 2020, Delay in Diagnosis of Patients with Head-and-Neck Cancer in Canada: Impact of Patient and Provider Delay, Curr. Oncol. sourceSupported

The different quality and functionality of patients' devices, such as camera resolutions, can impact the information quality gathered in remote consultation.

“The different quality and functionality of patients’ devices, such as camera resolutions, can impact the information quality gathered in remote consultation [244].”

• cites [244] Vasireddy, 2022, Technical Factors Can Impact on Remote Consultations in Rheumatology: Results from a Service Evaluation during the COVID-19 Pandemic, Rheumatol. Int. sourceSupported

The lack of remote physical exams, like abdominal assessments and vital checks, can create significant challenges in telemedicine, as essential clinical signals can be missed in video or phone consultations.

“The lack of remote physical exams, like abdominal assessments and vital checks, can create significant challenges in telemedicine, as essential clinical signals can be missed in video or phone consultations [241].”

• cites [241] Davoodi, 2021, Emergency Physician Perspectives on Using Telehealth with Older Adults during COVID-19: A Qualitative Study, J. Am. Coll. Emerg. Physicians Open sourceSupported

Given the mismatch between available time slots, clinician schedules, and patient needs, clinics often find it challenging to meet patients' expectations, especially during busy periods.

“Given the mismatch between available time slots, clinician schedules, and patient needs, clinics often find it challenging to meet patients’ expectations, especially during busy periods [20,276,277].”

• cites [20] Brondino, 2022, Missed Diagnoses and Misdiagnoses of Adults with Autism Spectrum Disorder, Eur. Arch. Psychiatry Clin. Neurosci. sourceCould not verify

  The Discussion (General findings; page unavailable) suggests that limited time for psychiatric assessment may contribute to missed ASD diagnoses. It does not address appointment availability, clinician schedules, patient expectations, or busy periods; searches for scheduling and wait-time terms found no passage supporting that claim. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites [276] Gupta, 2008, Appointment Scheduling in Health Care: Challenges and Opportunities, IIE Trans. sourceNot checked — no full text of the source
• cites [277] Kuiper, 2021, The Problem of Appointment Scheduling in Outpatient Clinics: A Multiple Case Study of Clinical Practice, Omega sourceNot checked — no full text of the source

Patients with IgG4-related disease (IgG4-RD), a rare inflammatory condition with symptoms associated with cancers or autoimmune disorders, ultimately often consult multiple specialists.

“For example, patients with IgG4-related disease (IgG4-RD), a rare inflammatory condition with symptoms associated with cancers or autoimmune disorders, ultimately often consult multiple specialists.”

• cites [274] Goodchild, 2020, Experience from the First UK Inter-Regional Specialist Multidisciplinary Meeting in the Diagnosis and Management of IgG4-Related Disease, Clin. Med. sourceSupported

The inability to palpate or acquire certain physical signs without advanced equipment can impede diagnostic judgment due to missed details.

“The inability to palpate or acquire certain physical signs without advanced equipment can impede diagnostic judgment due to missed details [238,239].”

• cites [238] Rothschild, 2021, Telemedicine in Musculoskeletal Health: Adaptations, Efficacy, and Implications for Practice, HSS J. sourcePartly supported

  The body text (indexed under “Keywords”; article pp. 360–361) says remote observation can miss signs needed to distinguish active synovitis from burnt-out disease and to recognize other conditions. It supports the diagnostic concern, but does not discuss whether advanced equipment would enable those signs to be acquired. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [239] Gerhardt, 2021, Assessing the Diagnostic Accuracy of Teledermatology Consultations at a Local Veterans Affairs Dermatology Clinic, Cureus sourcePartly supported

  The Conclusions identify the lack of tactile examination and image limitations as constraints on virtual assessment, and the Discussion reports additional diagnoses found during in-person examinations. These passages support the concern about missed details, but the paper does not discuss needing advanced equipment to acquire physical signs. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

A fear of hierarchies can stem from power imbalances and cultural taboos between senior and junior staff.

“A fear of hierarchies can stem from power imbalances [248,249] and cultural taboos [250] between senior and junior staff.”

• cites [248] (2024, November 17). Agency and Communion Predict Speaking Up in Acute Care Teams—Mona Weiss, Michaela Kolbe, Gudela Grote, Micha Dambach, Adrian Marty, Donat R. Spahn, Bastian Grande. Available online: https://journals.sagepub.com/doi/full/10.1177/1046496414531495?casa_token=OsGp4dV_tjUAAAAA:7RrZ4m2d6PZBzxu6GHwGqgsrJTg5MFKf5LGwM9uq_Qmp4SvGPxOtORnkhsFnxwZkuUE67RuwV8eRQA.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [249] Seiden, 2006, Role of Medical Students in Preventing Patient Harm and Enhancing Patient Safety, Qual. Saf. Health Care sourceSupported
• cites [250] Henriksen, K., Battles, J.B., Keyes, M.A., and Grady, M.L. (2008). Organizational Behavior Management in Health Care: Applications for Large-Scale Improvements in Patient Safety. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 2: Culture and Redesign), Agency for Healthcare Research and Quality (US). Advances in Patient Safety.Not checked yet

  Not checked in the free run.

As a result of device and instruction difficulties, the accuracy and quality of the diagnostic examination can be inconsistent.

“As a result, the accuracy and quality of the diagnostic examination can be inconsistent [246].”

• cites [246] Seuren, 2020, Physical Examinations via Video for Patients With Heart Failure: Qualitative Study Using Conversation Analysis, J. Med. Internet Res. sourceSupported

When a specialist discovers an error, they often avoid reporting it to the original specialist or making referrals about it.

“For example, when a specialist discovers an error, they often avoid reporting it to the original specialist or making referrals about it [254,255].”

• cites [254] Bell, 2017, Transparency When Things Go Wrong: Physician Attitudes About Reporting Medical Errors to Patients, Peers, and Institutions, J. Patient Saf. sourcePartly supported

  The Abstract (page unavailable) says clinicians face barriers to discussing errors with each other and report only a small minority of errors to institutions. The Discussion (page unavailable) likewise describes difficulties with transparency among peers. Neither passage establishes that a specialist who discovers another specialist’s error often avoids telling that original specialist or making referrals about it. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [255] Kale, 2017, Peers without Fears? Barriers to Effective Communication among Primary Care Physicians and Oncologists about Diagnostic Delays in Cancer, BMJ Qual. Saf. sourcePartly supported

  In Results, under “Fears about giving and receiving feedback” (page unavailable), an oncologist says they have never given a referring physician negative feedback about a possible diagnostic delay or error. This supports reluctance to report errors to another physician, but the study concerns communication between oncologists and referring primary care physicians; it does not establish that specialists avoid making referrals about errors. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Another challenge of remote consultations stems from infrastructure and device technical issues.

“Another challenge of remote consultations stems from infrastructure and device technical issues [234,243].”

• cites [234] Jnr, 2020, Use of Telemedicine and Virtual Care for Remote Treatment in Response to COVID-19 Pandemic, J. Med. Syst. sourceSupported
• cites [243] Rametta, 2020, Analyzing 2589 Child Neurology Telehealth Encounters Necessitated by the COVID-19 Pandemic, Neurology sourceSupported

When a patient has comorbidities or unusual features outside routine evaluation or treatment, clinicians often must provide additional justification or supporting documentation to request individual consideration or challenge unfavorable coverage decisions.

“However, when a patient has comorbidities or unusual features that fall outside routine evaluation or treatment, it is often the clinician who must provide additional justification or supporting documentation to request individual consideration or to challenge unfavorable coverage decisions [321].”

• cites [321] Shepard, 2012, An Analysis of AAN’s Evidence-Based Guideline for IVIg Use in Neurologic Disorders, Neurol. Clin. Pract. sourceSupported

Patient seat arrangement layout in the consultation room significantly influences clinician-patient interactions.

“The layout of patient seat arrangements in the consultation room can also significantly influence clinician-patient interactions.”

• cites [305] Floss, 2019, Where Is the Patient’s Chair? Differences in General Practitioner Consultation Room Layouts—An Exploratory Questionnaire, F1000Research sourceSupported

Frequent environmental distractions caused by noise, high pressure, and cognitive overload can interrupt clinicians' performance.

“Clinicians’ performance can be interrupted by frequent environmental distractions caused by noise, high pressure, and cognitive overload, leading to diagnostic errors and disruption of care transitions [297].”

• cites [297] Linzer, 2023, Improving Diagnosis: Adding Context to Cognition, Diagnosis sourceSupported

Constant eye strain and posture adjustments to see details more clearly will complicate and prolong the diagnostic process.

“Constant eye strain and posture adjustments to see details more clearly will complicate and prolong the diagnostic process [294].”

• cites [294] Dianat, 2013, Objective and Subjective Assessments of Lighting in a Hospital Setting: Implications for Health, Safety and Performance, Ergonomics sourceCould not verify

  The indexed copy contains bibliographic metadata and a repository note saying the article is unavailable, but no passage about eye strain, posture adjustments, or diagnostic time. Searches for those terms and related lighting effects returned no substantive passage, so the claim cannot be checked against this copy. (LLM, conf=0.72)

  Experimental — accuracy not yet measured

Insurance-related systemic issues often create significant challenges in obtaining prompt and accurate diagnostic services, especially for low-income individuals.

“Insurance-related systemic issues often create significant challenges in obtaining prompt and accurate diagnostic services, especially for low-income individuals [52].”

• cites [52] Richards, 2020, Time to Diagnosis and Factors Affecting Diagnostic Delay in Amyotrophic Lateral Sclerosis, J. Neurol. Sci. sourcePartly supported

  The Summary and conclusion (section 12; page not provided) says medical insurance restrictions or financial hardship may limit access to appropriate multidisciplinary care for people with ALS. It does not establish that these issues often cause significant difficulty obtaining prompt, accurate diagnostic services, or that low-income individuals are especially affected. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Financial constraints threaten accurate diagnosis as patients with high out-of-pocket expenses usually decline more advanced but costly imaging or tests.

“Financial constraints often threaten accurate diagnosis as patients with high out-of-pocket expenses usually decline more advanced but costly imaging or tests [320].”

• cites [320] Hughes, 2023, Patient Cost-Sharing and Utilization of Breast Cancer Diagnostic Imaging by Patients Undergoing Subsequent Testing After a Screening Mammogram, JAMA Netw. Open sourcePartly supported

  The Results and Discussion (page not provided) associate higher cost-sharing with less subsequent diagnostic breast imaging, especially MRI, and describe a potential barrier to early diagnosis. But the study concerns breast-imaging follow-up, not advanced tests generally; it does not show that patients usually decline testing, and it found no significant difference in breast biopsy use. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Lighting conditions like flickering, glare, and distracting shadows can induce visual discomfort.

“Lighting conditions like flickering, glare, and distracting shadows can induce visual discomfort.”

• cites [294] Dianat, 2013, Objective and Subjective Assessments of Lighting in a Hospital Setting: Implications for Health, Safety and Performance, Ergonomics sourceCould not verify

  The available copy contains a title, keywords, and citation metadata, but no substantive passage about flickering, glare, distracting shadows, or visual discomfort. Searches for those terms returned only metadata, so the claim cannot be checked against this copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Workstation distance and layout impact communication and patient interaction.

“Studies on the workstation’s distance and layout have shown their impact on communication and patient interaction.”

• cites [302] Gunn, 2015, Designing Clinical Space for the Delivery of Integrated Behavioral Health and Primary Care, J. Am. Board. Fam. Med. sourceSupported
• cites [303] Real, 2017, The Role of the Built Environment: How Decentralized Nurse Stations Shape Communication, Patient Care Processes, and Patient Outcomes, Health Commun. sourceNot checked — no full text of the source
• cites [304] Real, 2019, The Social Logic of Nursing Communication and Team Processes in Centralized and Decentralized Work Spaces, Health Commun. sourceNot checked — no full text of the source
• cites [305] Floss, 2019, Where Is the Patient’s Chair? Differences in General Practitioner Consultation Room Layouts—An Exploratory Questionnaire, F1000Research sourceSupported

Extended exposure to noise in healthcare environments impairs cognitive function, reducing concentration, precision, and work efficiency.

“Extended exposure to noise in healthcare environments, such as voices or equipment noise, can impair cognitive function, reducing concentration, precision, and work efficiency [293,298,299].”

• cites [293] Vischer, 2005, User evaluation of the work environment: A diagnostic approach, Le Trav. Hum. sourcePartly supported

  The Introduction (page not available) says noise can, under certain conditions, generate stress that negatively affects productivity. The office case study in Section IV.2 also describes noise disrupting co-workers. Neither passage addresses extended exposure in healthcare settings or establishes impaired cognition, concentration, or precision. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [298] Beyea, S.C. (2026, January 12). Interruptions and Distractions in Health Care: Improved Safety with Mindfulness, Available online: https://psnet.ahrq.gov/perspective/interruptions-and-distractions-health-care-improved-safety-mindfulness.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [299] Mariconte, R., Giliberti, C., Cavuto, C., and Strigari, L. (2015, January 12–16). Noise in Healthcare Facilities. Proceedings of the 22nd International Congress on Sound and Vibration, Florence, Italy.Not checked yet

  Not checked in the free run.

Sharing the same room in a cluttered and noisy space can disrupt medical and nursing staff thinking and reasoning for diagnostic results.

“Additionally, since medical and nursing staff often need to share the same room, the cluttered and noisy space can easily disrupt their thinking and reasoning for diagnostic results [115].”

• cites [115] Gupta, 2018, Mind the Overlap: How System Problems Contribute to Cognitive Failure and Diagnostic Errors, Diagnosis sourceSupported

Many contributory data are not easily extracted and are often fragmented in medical records or facility data, leaving important human and contextual information unconsidered when measuring diagnostic errors.

“However, many of the contributory data are not easily extracted and are often fragmented in medical records or facility data, leaving important human and contextual information unconsidered when measuring diagnostic errors [356].”

• cites [356] Singh, 2013, Types and Origins of Diagnostic Errors in Primary Care Settings, JAMA Intern. Med. sourcePartly supported

  The Discussion (page not provided) says the retrospective study lacked practitioner debriefing, which could have supplied additional useful data. That supports the possibility of missing contextual information, but the paper does not say contributory data are difficult to extract or fragmented across medical records or facility data. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

In HSAT devices, usability testing helps prevent errors such as incorrect sensor placement or failure to activate the device due to unclear displays or inadequate instructions.

“In HSAT devices, usability testing helps prevent errors such as incorrect sensor placement or failure to activate the device due to unclear displays or inadequate instructions [328].”

• cites [328] Park, 2024, FDA-Cleared Home Sleep Apnea Testing Devices, npj Digit. Med. sourcePartly supported

  The Discussion (page not specified) links usability-related specifications and interface design to minimizing usage errors in HSAT devices. It does not identify incorrect sensor placement, failure to activate a device, unclear displays, or inadequate instructions as examples, nor does it specifically assess whether usability testing prevents those errors. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Some accreditation programs provide continuing learning to further support diagnostic safety, such as the Joint Accreditation for Interprofessional Continuing Education.

“Therefore, some accreditation programs provide continuing learning to further support diagnostic safety, such as the Joint Accreditation for Interprofessional Continuing Education [355].”

• cites [355] Regnier, 2022, Leading Change Together: Supporting Collaborative Practice through Joint Accreditation for Interprofessional Continuing Education, J. Eur. CME sourcePartly supported

  The Introduction (page not provided) identifies Joint Accreditation for Interprofessional Continuing Education as an accrediting body through which providers offer continuing education, and links that education to healthcare quality and safety. It does not specifically address diagnostic safety, so the claim's narrower purpose is not established by this source. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Diagnostic processes differ across care settings in terms of workflow, communication needs, and resources.

“Since diagnostic processes differ across care settings in terms of workflow, communication needs, and resources, organizational strategies for diagnostic safety should be tailored to each specific setting [373,374].”

• cites [373] Burden, 2025, Unlocking Inpatient Workload Insights with Electronic Health Record Event Logs, J. Hosp. Med. sourcePartly supported

  In “Defining the Measures” (page unavailable), the paper says inpatient workflows differ considerably from outpatient workflows, including in communication patterns and team structures. It discusses tailoring EHR event-log measures to inpatient work, but does not establish that diagnostic processes differ across settings in their resource needs. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [374] Singh, 2017, The Global Burden of Diagnostic Errors in Primary Care, BMJ Qual. Saf. sourcePartly supported

  The Introduction describes primary-care diagnostic workflow, and the Epidemiology section contrasts diagnostic resources in low- and high-resource settings. The paper also identifies communication and coordination as diagnostic-process concerns, but it does not clearly establish that workflow and communication needs differ across care settings or explicitly call for organizational strategies tailored to each setting. Page numbers were not available in our copy. (LLM, conf=0.80)

  Experimental — accuracy not yet measured

TJC-accredited hospitals often perform better on quality measures assessing the delivery of healthcare services according to evidence-based standards.

“TJC-accredited hospitals often perform better on quality measures assessing the delivery of healthcare services according to evidence-based standards [350].”

• cites [350] Schmaltz, 2011, Hospital Performance Trends on National Quality Measures and the Association with Joint Commission Accreditation, J. Hosp. Med. sourceSupported

Women with breast cancer who had self-examination knowledge were found to be more aware of any abnormalities and sought help from the physician earlier than those without that knowledge.

“women with breast cancer who had self-examination knowledge were found to be more aware of any abnormalities and sought help from the physician earlier than those without that knowledge [25].”

• cites [25] Barwise, 2021, What Contributes to Diagnostic Error or Delay? A Qualitative Exploration Across Diverse Acute Care Settings in the United States, J. Patient Saf. sourceNot checked — no full text of the source

Many contributory factors to diagnostic errors do not function within a single SEIPS domain but instead interact across domains and shape the diagnostic system as a whole.

“A key theme emerging from this review is that many contributory factors to diagnostic errors do not function within a single SEIPS domain but instead interact across domains and shape the diagnostic system as a whole (Figure 2).”

The effectiveness of diagnostics is influenced by complex, interconnected factors spanning all six SEIPS domains.

“The findings reveal that the effectiveness of diagnostics is influenced by complex, interconnected factors spanning all six SEIPS domains.”

• AssumptionRests on an assumption: The six SEIPS domains are sufficient to capture all relevant contributory factors to diagnostic error.

When individuals can comprehend health-related information, they are more likely to recognize early warning signs of disease.

“When individuals can comprehend health-related information, they are more likely to recognize early warning signs of disease.”

Although many contributors to diagnostic error have been identified, they are typically discussed in isolation rather than as part of an interacting system.

“Although many contributors to diagnostic error have been identified in the previous literature, they are typically discussed in isolation rather than as part of an interacting system [25,33].”

• cites [25] Barwise, 2021, What Contributes to Diagnostic Error or Delay? A Qualitative Exploration Across Diverse Acute Care Settings in the United States, J. Patient Saf. sourceNot checked — no full text of the source
• cites [33] Graber, 2005, Diagnostic Error in Internal Medicine, Arch. Intern. Med. sourceNot checked — no full text of the source

Delays in referrals are a common issue in the diagnostic process.

“Delays in referrals are also a common issue in the diagnostic process.”

In some religions, seeking sexual health care and having HIV/AIDS can be regarded as sinful and inappropriate, particularly for unmarried women.

“In some religions, seeking sexual health care and having HIV/AIDS can be regarded as sinful and inappropriate, particularly for unmarried women [81].”

• cites [81] Parekh, R., and Childs, E.W. (2016). Religious Minorities and Medicine: The Collision of Health Care and Faith. Stigma and Prejudice: Touchstones in Understanding Diversity in Healthcare, Springer International Publishing. sourceNot checked — no full text of the source

Patient characteristics, such as health literacy and disease awareness, affect how individuals can articulate their symptoms and understand treatment instructions, which directly impacts the diagnostic process.

“patient characteristics, such as health literacy and disease awareness, affect how individuals can articulate their symptoms and understand treatment instructions, which directly impacts the diagnostic process [24,25].”

• cites [24] Wittink, 2018, Patient Education and Health Literacy, Musculoskelet. Sci. Pract. sourceNot checked — no full text of the source
• cites [25] Barwise, 2021, What Contributes to Diagnostic Error or Delay? A Qualitative Exploration Across Diverse Acute Care Settings in the United States, J. Patient Saf. sourceNot checked — no full text of the source

A lack of knowledge about the disease can prevent patients from realizing the severity of their condition and seeking medical help until the symptoms worsen, especially for older adults.

“A lack of knowledge about the disease can prevent patients from realizing the severity of their condition and seeking medical help until the symptoms worsen, especially for older adults.”

Affective and motivational problems can result in missed appointments.

“Affective and motivational problems can result in missed appointments [68].”

• cites [68] Moscrop, 2012, Mental Health of Young Adult Patients Who Do Not Attend Appointments in Primary Care: A Retrospective Cohort Study, Fam. Pract. sourceNot checked — no full text of the source

Patient health literacy plays a crucial role in how accurately and quickly diagnoses are made.

“Patient health literacy plays a crucial role in how accurately and quickly diagnoses are made.”

Patients often feel embarrassed or fearful about their diseases due to stigma and worry about judgment from friends, family, or society.

“Patients often feel embarrassed or fearful about their diseases due to the stigma and worry about judgment from friends, family, or society [79].”

• cites [79] Chang, 2008, Increasing Mental Health Literacy via Narrative Advertising, J. Health Commun. sourceNot checked — no full text of the source

Patients with mental conditions face several barriers to communicating their symptoms.

“Patients with mental conditions face several barriers to communicating their symptoms.”

The quality and completeness of information exchange are shaped by both communication and the relationship between patient and clinician, which directly impacts diagnostic outcomes.

“The quality and completeness of information exchange are shaped by both communication and the relationship between patient and clinician, which directly impacts diagnostic outcomes [26].”

• cites [26] Huynh, 2023, Understanding Diagnostic Conversations in Clinical Practice: A Systematic Review, Patient Educ. Couns. sourceNot checked — no full text of the source

Studies that capture diagnostic error have mainly emphasized timeliness and accuracy, due to the complexity of identifying and documenting communication-related diagnostic errors.

“Studies that capture diagnostic error have mainly emphasized timeliness and accuracy, due to the complexity of identifying and documenting communication-related diagnostic errors.”

Diagnostic errors can manifest in different ways among clinicians, depending on their specialty.

“Diagnostic errors can manifest in different ways among clinicians, depending on their specialty.”

Anxiety and somatization disorders can lead to exaggerated symptom histories inappropriately.

“Anxiety and somatization disorders can also lead to exaggerated symptom histories inappropriately.”

A clinician's professional knowledge and previous experience can significantly influence symptom interpretation and diagnosis.

“A clinician’s professional knowledge and previous experience can significantly influence symptom interpretation and diagnosis.”

Cultural and social disparities, including ethnic background and language barriers, can influence how patients interact with providers.

“Cultural and social disparities, including ethnic background and language barriers, can also influence how patients interact with providers [71,72].”

• cites [71] Ferguson, 2002, Culture, Language, and the Doctor-Patient Relationship, Fam. Med.Not checked — no full text of the source
• cites [72] Medlock, M.M., Shtasel, D., Trinh, N.-H.T., and Williams, D.R. (2019). Clinician Bias in Diagnosis and Treatment. Racism and Psychiatry: Contemporary Issues and Interventions, Springer International Publishing. sourceNot checked — no full text of the source

When multiple guidelines are used simultaneously, patients experience cumulative treatment burdens.

“When multiple guidelines are used simultaneously, patients will experience cumulative treatment burdens.”

• cites [153] NICE (2003). National Institute for Health and Care Excellence: Guidelines, National Institute for Health and Care Excellence (NICE).Not checked yet

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• cites [154] Muth, 2019, Evidence Supporting the Best Clinical Management of Patients with Multimorbidity and Polypharmacy: A Systematic Guideline Review and Expert Consensus, J. Intern. Med. sourceNot checked — no full text of the source
• cites [155] Hughes, 2013, Guidelines for People Not for Diseases: The Challenges of Applying UK Clinical Guidelines to People with Multimorbidity, Age Ageing sourceNot checked — no full text of the source

Noticeable symptoms like a visible mass generally result in more prompt referrals and quicker diagnoses.

“On the other hand, noticeable symptoms, like a visible mass, generally result in more prompt referrals and quicker diagnoses [137].”

• cites [137] Goyal, 2004, Symptom Interval in Young People with Bone Cancer, Eur. J. Cancer sourceNot checked — no full text of the source

Patient information such as age, name, sex, and ethnicity can distract clinicians by leading them to focus on these characteristics rather than objectively evaluating the patient's symptoms and physical conditions.

“Patient information such as age, name, sex, and ethnicity can distract clinicians by leading them to focus on these characteristics rather than objectively evaluating the patient’s symptoms and physical conditions.”

Children with bone tumors often present non-specific symptoms such as pain or fatigue, which can be easily labeled as minor or common concerns.

“For example, children with bone tumors often present non-specific symptoms, such as pain or fatigue, which can be easily labeled as minor or common concerns.”

• cites [137] Goyal, 2004, Symptom Interval in Young People with Bone Cancer, Eur. J. Cancer sourceNot checked — no full text of the source

Information such as pre-existing notes from prior consultants, normal imaging results, and the presence of yellow flags directs clinicians to focus on their original diagnostic hypothesis without further questioning secondary or alternative possibilities.

“Information such as pre-existing notes from prior consultants, normal imaging results, and the presence of yellow flags directs clinicians to focus on their original diagnostic hypothesis without further questioning secondary or alternative possibilities [99].”

• cites [99] Murani, 2021, Avoiding Anchoring Bias in Unexplained Chronic Pain: An Unexpected Diagnosis of Synovial Osteochondromatosis, BMJ Case Rep. CP sourceNot checked — no full text of the source

Overlapping symptoms can be hard to differentiate, particularly during advanced diagnostic assessments.

“Sometimes, overlapping symptoms can be hard to differentiate, particularly during advanced diagnostic assessments [128].”

• cites [128] Maixner, 2016, Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification, J. Pain sourceNot checked — no full text of the source

For emerging diseases, limited data and evolving traits make consistency difficult.

“This is particularly true for emerging diseases, where limited data and evolving traits make consistency difficult [156].”

• cites [156] Beigel, 2009, Toward Better Clinical Data in Emerging Infectious Diseases, Clin. Infect. Dis. sourceNot checked — no full text of the source

The absence of guidance on prioritizing treatment plans for patients with multiple conditions makes the care process overwhelming and difficult to manage.

“The absence of guidance on prioritizing treatment plans for patients with multiple conditions makes the care process overwhelming and difficult to manage.”

Patients with site-specific symptoms are more likely to raise the alarm for clinicians regarding urgent referrals.

“Patients with site-specific symptoms, located in a particular area of the body, are more likely to raise the “alarm” for clinicians regarding urgent referrals [135].”

• cites [135] Bosch, 2024, Time to Diagnosis and Presenting Symptoms of Patients Diagnosed with Cancer Through Emergency and Nonemergency Routes: A Large Retrospective Study From a High-Volume Center, JCO Oncol. Pract. sourceNot checked — no full text of the source

Overconfidence leads to quicker, less thorough diagnostic evaluations, increasing the risk of errors by prematurely closing the diagnostic process and failing to consider alternative possibilities.

“Overconfidence leads to quicker, less thorough diagnostic evaluations, increasing the risk of errors by prematurely closing the diagnostic process and failing to consider alternative possibilities [105].”

• cites [105] Lam, 2020, Are We Right When We’re Certain? Overconfidence in Medicine, R I Med. J. (2013)Not checked — no full text of the source

The copy-paste practice is commonly seen in busy clinical settings where time pressure is imposed on clinicians to complete documentation quickly.

“This practice is commonly seen in busy clinical settings where time pressure is imposed on clinicians to complete documentation quickly [182].”

• cites [182] Kaushal, 2008, Physicians’ Attitudes Towards Copy and Pasting in Electronic Note Writing, J. Gen. Intern. Med.Not checked yet

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The uncertainty caused by overlapping symptoms with other conditions and the lack of an objective biomarker can lead to potential diagnostic challenges for IBS.

“The uncertainty caused by overlapping symptoms with other conditions and the lack of an objective biomarker can lead to potential diagnostic challenges [188].”

• cites [188] Soares, 2014, Irritable Bowel Syndrome: A Clinical Review, World J. Gastroenterol. sourceNot checked — no full text of the source

Interoperability problems when transferring data between two different medical record systems can result in absent final diagnoses or national diagnostic codes, compromising the quality of the information and leading to diagnostic errors.

“Additionally, interoperability problems when transferring data between two different medical record systems can result in absent final diagnoses or national diagnostic codes, compromising the quality of the information and leading to diagnostic errors [179].”

• cites [179] Khajouei, 2018, Errors and Causes of Communication Failures from Hospital Information Systems to Electronic Health Record: A Record-Review Study, Int. J. Med. Inform. sourceNot checked — no full text of the source

More than 87% of ICU doctors indicated that they faced adverse events related to communication issues during handoffs, such as omissions or misunderstandings of crucial diagnostic details, including pending results and required follow-up care.

“More than 87% of ICU doctors indicated that they faced adverse events related to communication issues during handoffs, such as omissions or misunderstandings of crucial diagnostic details, including pending results and required follow-up care [270].”

• cites [270] Santhosh, 2019, Characterising ICU–Ward Handoffs at Three Academic Medical Centres: Process and Perceptions, BMJ Qual. Saf. sourceNot checked — no full text of the source

Inconsistencies arise between verbal handoffs and EHRs.

“Moreover, this problem can go beyond personal communication; inconsistencies arise between verbal handoffs and EHRs.”

• cites [271] Maughan, 2011, ED Handoffs: Observed Practices and Communication Errors, Am. J. Emerg. Med. sourceNot checked — no full text of the source

The high proportion of malpractice payments for diagnostic errors is primarily due to the difficulties in recognizing subtle symptoms during a single outpatient visit, making follow-up and accurate diagnosis more difficult.

“This is primarily due to the difficulties in recognizing subtle symptoms during a single outpatient visit, making follow-up and accurate diagnosis more difficult [261].”

• cites [261] Bishop, 2011, Paid Malpractice Claims for Adverse Events in Inpatient and Outpatient Settings, JAMA sourceNot checked — no full text of the source

Physical examinations are the major constraint in remote consultation.

“Physical examinations are the major constraint in remote consultation.”

Non-verbal cues, such as facial expressions, body language, and subtle symptom presentation, can be ignored or unobserved during remote consultation.

“Moreover, non-verbal cues, such as facial expressions, body language, and subtle symptom presentation, can be ignored or unobserved during remote consultation.”

• cites [242] Lee, 2021, The Value of Physical Examination in the Era of Telemedicine, J. R. Coll. Physicians Edinb. sourceNot checked — no full text of the source

The missing detailed observations in remote consultation may be crucial for diagnoses.

“The missing detailed observations may be crucial for diagnoses [242].”

• cites [242] Lee, 2021, The Value of Physical Examination in the Era of Telemedicine, J. R. Coll. Physicians Edinb. sourceNot checked — no full text of the source

The lack of transparency in AI-based and complex CDSS compared to rule-based systems often makes their errors harder for clinicians to predict and understand.

“Additionally, the lack of transparency in AI-based and complex CDSS compared to rule-based systems often makes their errors harder for clinicians to predict and understand.”

• cites [233] Jussupow, 2021, Augmenting Medical Diagnosis Decisions? An Investigation into Physicians’ Decision-Making Process with Artificial Intelligence, Inf. Syst. Res. sourceNot checked — no full text of the source

Increased distance can foster more private conversations with patients and other staff members.

“On the other hand, the increased distance can foster more private conversations with patients and other staff members, but it may raise potential concerns regarding delayed response times and reduced peer support [303,304].”

• cites [303] Real, 2017, The Role of the Built Environment: How Decentralized Nurse Stations Shape Communication, Patient Care Processes, and Patient Outcomes, Health Commun. sourceNot checked — no full text of the source
• cites [304] Real, 2019, The Social Logic of Nursing Communication and Team Processes in Centralized and Decentralized Work Spaces, Health Commun. sourceNot checked — no full text of the source

Examination table design can significantly impact clinicians' ability to collect detailed information comprehensively and accurately.

“In addition, the design of the examination table can significantly impact clinicians’ ability to collect detailed information with greater comprehensiveness and accuracy.”

• cites [312] Freihoefer, 2013, Clinic Exam Room Design: Present and Future, HERD sourceNot checked — no full text of the source

The position of exam tables can significantly influence evaluation completeness and result accuracy.

“If assessment and procedural requirements are considered, the position of exam tables can significantly influence evaluation completeness and result accuracy [312].”

• cites [312] Freihoefer, 2013, Clinic Exam Room Design: Present and Future, HERD sourceNot checked — no full text of the source

Radiologists rely on proper ambient lighting to balance image luminance and minimize glare.

“For example, radiologists rely on proper ambient lighting to balance image luminance and minimize glare.”

• cites [295] Degnan, 2019, Perceptual and Interpretive Error in Diagnostic Radiology—Causes and Potential Solutions, Acad. Radiol. sourceNot checked — no full text of the source

Clinicians may have difficulty staying vigilant under the heavy workload.

“Additionally, clinicians may have difficulty staying vigilant under the heavy workload [25,281].”

• cites [25] Barwise, 2021, What Contributes to Diagnostic Error or Delay? A Qualitative Exploration Across Diverse Acute Care Settings in the United States, J. Patient Saf. sourceNot checked — no full text of the source
• cites [281] Apornak, 2021, Human Resources Allocation in the Hospital Emergency Department during COVID-19 Pandemic, Int. J. Healthc. Manag. sourceNot checked — no full text of the source

The allocation of diagnostic tools such as CT and MRI frequently faces obstacles due to inflexible scheduling slots.

“The allocation of diagnostic tools such as CT and MRI frequently faces obstacles due to inflexible scheduling slots.”

• cites [290] Xie, 2021, Analytics for Hospital Resource Planning—Two Case Studies, Prod. Oper. Manag. sourceNot checked — no full text of the source

In order to accommodate high patient demand, clinicians will have to shorten consultation times.

“In order to accommodate high patient demand, clinicians will have to shorten consultation times [276].”

• cites [276] Gupta, 2008, Appointment Scheduling in Health Care: Challenges and Opportunities, IIE Trans. sourceNot checked — no full text of the source

Financial elements can affect access to timely and suitable diagnostic services, leading to potential delays or errors when affordability or insurance obstacles emerge.

“These financial elements can affect one’s access to timely and suitable diagnostic services, leading to potential delays or errors when affordability or insurance obstacles emerge.”

• AssumptionRests on an assumption: High out-of-pocket expenses and coverage barriers deter patients from seeking timely medical help.

The ability to detect subtle findings during physical exam can be reduced in noisy settings.

“For example, the ability to detect subtle findings during the physical exam can be reduced, particularly in noisy settings.”

A study on skin biopsies found that dermatologists' accuracy tends to decrease toward the end of the day, especially on Fridays.

“A study on skin biopsies found that dermatologists’ accuracy tends to decrease toward the end of the day, especially on Fridays.”

• cites [286] Dadrass, 2022, LB958 A Retrospective Study of Skin Biopsy Diagnostic Accuracy among Dermatologists throughout the Day: Do Physicians Experience Diagnostic or Procedure Fatigue?, J. Investig. Dermatol. sourceNot checked — no full text of the source

Using overbooking as a solution to no-shows and last-minute cancelations often causes an increase in patients' wait time and clinicians' overtime.

“To address the issues resulting from no-shows and last-minute cancelations, using overbooking as a solution often causes an increase in patients’ wait time and clinicians’ overtime [278].”

• cites [278] LaGanga, 2007, Clinic Overbooking to Improve Patient Access and Increase Provider Productivity*, Decis. Sci. sourceNot checked — no full text of the source

Clinicians often focus more on common or easily treatable conditions, potentially overlooking subtle diagnostic signs or symptoms due to time pressure.

“Therefore, clinicians often focus more on common or easily treatable conditions, potentially overlooking subtle diagnostic signs or symptoms due to time pressure.”

Exam room size and clearance space around exam tables determine staff ability to assist with patient transfers and positioning for a more thorough examination.

“The size of the exam room and the availability of clearance space around the exam tables also determine the staff’s ability to assist with patient transfers and positioning for a more thorough examination [315].”

• cites [315] (2024, September 07). Access to Medical Care for Individuals with Mobility Disabilities, Available online: https://www.ada.gov/resources/medical-care-mobility/.Not checked yet

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Lighting quality affects the accurate display of skin tones essential for diagnosing conditions like anemia or jaundice.

“The importance of lighting quality can also be seen in dermatology, as it affects the accurate display of skin tones essential for diagnosing conditions like anemia or jaundice.”

• cites [296] Allahdadi, M., Hashemi, M., and Hajivand, K. (2018, January 18–19). Assessing the Satisfaction of Dermatologists with Examination Equipment (Case Study: Color Recognition Tools). Proceedings of the International Conference on Marketing and Design: Intersection and Challenges, Faro, Portugal.Not checked yet

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The ONC ensures the usability of diagnostic products by regulating the digital infrastructure that supports them.

“Similarly to the FDA, the ONC ensures the usability of diagnostic products by regulating the digital infrastructure that supports them.”

The examples and evidence referenced in this review predominantly draw on studies conducted in U.S.-based, high-income healthcare systems.

“The examples and evidence referenced in this review predominantly draw on studies conducted in U.S.-based, high-income healthcare systems.”

Factors such as patients' health literacy, communication quality, socio-behavioral factors, clinical reasoning, clinicians' cognitive bias, tools and technology used, and organizational and administrative rules and culture play a large role in diagnostic outcomes.

“As shown in this literature review, factors such as patients’ health literacy, communication quality, socio-behavioral factors, clinical reasoning, clinicians’ cognitive bias, tools and technology used, and organizational and administrative rules and culture play a large role in diagnostic outcomes.”

• AssumptionRests on an assumption: Low health literacy and cultural barriers often limit patient communication and medical instruction adherence.

Accreditation plays an important role in reducing diagnostic errors.

“Accreditation plays an important role in reducing diagnostic errors.”

Core skills and knowledge tested, such as problem-solving and clinical decision-making, have been shown to correlate with diagnostic accuracy in practice.

“Some core skills and knowledge tested, such as problem-solving and clinical decision-making, have been shown to correlate with diagnostic accuracy in practice [92].”

• cites [92] Norman, 2014, The Etiology of Diagnostic Errors: A Controlled Trial of System 1 Versus System 2 Reasoning, Acad. Med. sourceNot checked — no full text of the source

A commercial laboratory referred proficiency testing samples between its own branches, which can artificially boost performance results and give a misleading impression of testing accuracy.

“For example, a commercial laboratory was found to have referred proficiency testing (PT) samples between its own branches, which can artificially boost performance results and give a misleading impression of testing accuracy.”

• cites [332] Killeen, 2009, Laboratory Sanctions for Proficiency Testing Sample Referral and Result Communication: A Review of Actions From 1993–2006, Arch. Pathol. Lab. Med. sourceNot checked — no full text of the source

Some contributory factors, particularly those related to access to diagnostic tools, digital infrastructure, insurance structures, and policy and regulation, could differ substantially in low- and middle-income settings.

“As a result, some contributory factors, particularly those related to access to diagnostic tools, digital infrastructure, insurance structures, and policy and regulation, could differ substantially in low- and middle-income settings.”

Such behavior compromises the regulatory system intended to protect patient safety and ensure the reliability of tests.

“Such behavior compromises the regulatory system intended to protect patient safety and ensure the reliability of tests [332].”

• cites [332] Killeen, 2009, Laboratory Sanctions for Proficiency Testing Sample Referral and Result Communication: A Review of Actions From 1993–2006, Arch. Pathol. Lab. Med. sourceNot checked — no full text of the source

Usability testing is required for diagnostic devices such as low-field MRI systems and home sleep apnea testing devices because user interaction can be directly linked to outcomes.

“For example, usability testing is required for diagnostic devices such as low-field magnetic resonance imaging (MRI) systems and home sleep apnea testing (HSAT) devices, as user interaction can be directly linked to outcomes.”

The FDA is responsible for overseeing the usability of diagnostic devices in addition to regulating their reliability and accuracy.

“In addition to regulating the reliability and accuracy of diagnostic tools, the FDA is also responsible for overseeing the usability of diagnostic devices.”