José M

Diagnostic errors in medical practice.

Changing the culture around medical errors is one of the most important challenges faced by medicine and other health care disciplines. Such change began more than two decades ago, but has barely been implemented; so the challenge ahead of us is enormous. Notwithstanding, and although at a slow pace, several goals have been achieved in terms of patient safety that help to reduce errors and risks in medical care. Diagnostic errors have been in the spotlight lately, and mechanisms and adverse events related to such errors are now being better understood. Their actual frequency is unknown; although our wrong decisions are more common than what we thought: the rate of diagnostic errors is estimated to be at least 25%. A systematic review assessed thousands of autopsies from 1966 to 2002 and detected diagnostic errors as a probable cause of death. The mean rate of errors was 23.5% (Shojania KG, et al. JAMA 2003). It is worth pointing out that diagnostic errors lead to more adverse events than other types of error, which reach 15-20%, and are also the hardest to prevent.In spite of such worrying information, medical literature on these errors is more limited than on any other. Likewise, it should be noted that diagnostic errors are the main reason for medical liability and malpractice litigation and greatly exceed the number of lawsuits related to surgical procedures and medication errors. Several unfavorable factors of medical practice have an impact on diagnostic failures, especially because they unduly interfere with patient-physician relationships. At present office visits are shorter and shorter, resulting in very little dialogue with patients or their parents and therefore, in little time to listen to them. From ancient times our language has been an instrument of inquiry and knowledge that was based on three essential conditions: empathy, communication skills, and the necessary time to let words unfold their power. Today this has become an uncommon gift because, for several reasons, communication has replaced dialogue with a long series of surrogates. These days there is also wide access to medical information, which is mostly irrelevant and far exceeds what is necessary to be a good doctor. This may lead, or probably has already led, to the risk of having doctors who are only supported by copious amounts of recent information, who also assume they have a vast knowledge, when it is usually the opposite.