Eighty percent of the errors were due to communication breakdowns between the patient and practitioner. This could have been failing to take a proper medical history or not performing a comprehensive physical exam. There also were problems with ordering and interpreting tests and follow-up care.
More than 40 percent of the cases studied involved more than one of these factors.
Although all the cases reviewed in this study involved patients coming back for -- and receiving -- follow-up care, the cases did have the potential for "moderate to severe harm," the authors said.
It's not clear if these findings would extrapolate into other primary care settings, especially ones that aren't part of a larger health care network, the authors said. (Even in this study, the authors found different patterns in the VA network versus the private system.)
The authors did not say what proportion of total diagnoses were in error, said Dr. Doug Campos-Outcalt, chairman of family medicine at the University of Arizona College of Medicine, in Phoenix.
But few people would deny that primary-care physicians are overworked, underpaid and stressed for time, so fixing such errors is likely to be a long-term process.
Having electronic medical records systems and medical "homes," a concept that has been developed where patients can get many of their health care needs met in one place, may reduce diagnostic errors, but how common either will eventually become is still unclear, Singh said.
Giving doctors more support from a team of nurses and other health care professionals, along with complete electronic medical health records on patients, also may help, Singh said.
Patients can also play a role.
"If you have five symptoms, you need to be patient so you can tell the doctor what's going on properly," Singh said. "Getting the story right is important. Following through with instructions is i
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