The wrong diagnosis: identifying causes of potentially adverse events in general practice using incident monitoring

Background. Although recognized by both patients and practitioners as a highly undesirable outcome, little is known about the factors which contribute to wrong diagnoses. Data collected through a pilot study of incident monitoring in general practice in Australia were examined to identify possible types of diagnostic incidents and their likely causes. Objectives. The aim was to identify how diagnostic incidents occur and to illuminate preventable and especially system causes of such incidents. Methods. GP participants anonymously reported any event of potential harm to their patients, using both free text and structured-response categories. Free text was analysed qualitatively for common themes, while fixed format responses were used to provide an overall description of the data. Results. Diagnostic incidents occurred because of errors in judgement, particularly in the formation and evaluation of diagnostic hypotheses. Other problems related to systems of information transfer and medical records, and to poor communication between patients and health providers and between health professionals, which resulted in less than ideal care. Conclusion. Incident monitoring is a useful tool for identifying sources of misdiagnosis and for implementation and assessment of quality improvement strategies.