Diagnostic error in medicine: introduction.

In 1999 the Institute of Medicine (a division of the US National Academy of Sciences) published a landmark report indicating that from 44,000 to 98,000 deaths per year could be attributed to preventable medical errors (Kohn et al. 1999). Although the majority of errors related to therapy, including medication and surgical errors, the report identified a significant number of diagnostic errors. Until recently, most of the research in patient safety had not addressed these errors. In the last few years there has been increased recognition of the prevalence and severity of diagnostic errors. In 2007 the US Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) identified diagnostic errors as an area of special emphasis. (http://grants.nih.gov/grants/guide/notice-files/ NOT-HS-08-002.html). There is a background of research that is relevant to this newly recognized domain. Several patient safety and quality improvement researchers have focused on analyzing and characterizing errors and their impact, figuring what went wrong, why, and how can we fix it (Schiff 1994; Schiff et al. 2005; Croskerry 2000a, b, 2002, 2003a, b, c, 2005; Croskerry and Wears 2003; Cosby and Croskerry 2003; Graber et al. 2002; Graber 2004; Graber et al. 2005). In addition to a few patient safety/quality improvement researchers’ interests in diagnostic errors, three other research domains have a longer history than the more recent interest in diagnostic errors within the patient safety arena, addressing fundamental questions about how humans make diagnoses and strategies to improve the process. These research domains are: