More than half the ‘missed diagnostic opportunities’ found in a study of general practice records relate to history taking, physical examination or ordering of diagnostic tests during a consultation, a study has shown.
Analysis of a random sample of consultations across a year at 21 practices before the Covid-19 pandemic found only around one in 23 consultations had diagnostic errors.
The authors noted GPs have a demanding job and make accurate assessments in the ‘vast majority of cases’, but said finding ways to help GPs avoid mistakes should be an ‘urgent priority’ due to the potential harm to patients.
Of the 4.3% of consultations where GP researchers identified missed diagnostic opportunities, 37% were assessed to have caused moderate or severe patient harm – 0.016% of the total, a study in BMJ Quality and Safety reports.
Other factors in diagnostic errors identified by the research of 2,057 randomly selected patients related to tests being ordered and not done, understanding and follow up of diagnostic tests, such as incorrectly interpreting a HbA1c test for diabetes.
In 12% of the missed diagnostic opportunities found there were problems with referral including one being made to a specialist but not acted on. In 6% of cases the issue laid with the patient, for example not attending a specialist appointment.
A large proportion (72%) of the diagnostic errors had more than one contributing factor, the researchers from the University of Manchester found.
Overall there were 89 missed diagnoses in the study including urine infections, nine metabolic or endocrine issues and five cases involving tumours of some kind.
The researchers pointed out that the risk of error may rise with increasing workload pressures, patient care across multiple settings of care, resource-constrained work environments, complexity of patients as well as clinician stress and burnout.
Covid-19 and its associated pressures are likely to have increased the risk of missed diagnostic opportunity for many reasons, they added.
It follows a study published in 2020 that found that better use of IT systems and more continuity of care in general practice could help reduce cases of ‘avoidable significant harm’ such as missed diagnosis or medication errors.
Study leader Dr Sudeh Cheraghi-Sohi, a research fellow, said understanding diagnostic errors in general practice is vital for understanding how to make healthcare safer for patients.
‘While it’s important to point out that we found multiple reasons for errors, including issues between GPs and hospitals, the majority happened during a patient’s consultation with their GP and this is where efforts should be targeted to reduce these errors.
‘More than 300 million consultations take place every year in general practice. This means that there are several million patients potentially at risk of avoidable harm from a misdiagnosis each year.’
Co-author Professor David Reeves, added: ‘GPs do a challenging and demanding job and often see patients with unclear symptoms and complex medical histories. Despite this, our research has shown, they make accurate diagnoses in the vast majority of cases.
‘The occasional misdiagnosis is not surprising but can have serious long-term consequences for the patient and be devastating for the clinician as well.
‘Finding ways to help GPs avoid diagnostic mistakes is an urgent priority.’