Improving Diagnosis: Evaluation of Diagnostic Experiences Classified as Problems, Mistakes, or Both by Patients and Care Partners From a Nationally Representative Survey.

Abstract

Background: Understanding patients' experiences with diagnosis is crucial for improving care. Clarifying how best to ask about these experiences is an essential step in doing so.

Objective: To elicit and then categorize diagnostic problems and mistakes in a national, population-based survey.

Methods: Drawing from a nationally representative panel, respondents were asked whether they had experienced (directly or as a care partner) a diagnostic problem or mistake in the last 4 years. They then classified the experience as a mistake, a problem only, or a combination of both. Respondents who experienced multiple problems and mistakes reported on their most memorable experience. We compared responses among those reporting a problem, a mistake, or a combination of both.

Results: A third [1216/3684 (33.0%)] of screened households reported diagnostic problems or mistakes involving themselves [697/3684 (18.9%)] or someone close to them [519/3684 (14.1%)]. A plurality [448/3684 (12.2%)] categorized these as a mistake, 382 (10.4%) as a problem, and 371 (10.1%) as both. Experiences reported as problems versus mistakes were equally likely to be associated with harmful consequences and concrete clinician responses. The distribution of problems and mistakes across the 3 categories did not significantly differ when reported by patients versus care partners, though there were checkered differences in the reported impact.

Conclusions: Whether labeled as problems or mistakes, diagnostic experiences reported by patients and care partners are accompanied by substantial emotional, physical, and financial impacts. Responding to this full range of patient experiences is important for guiding improvements in diagnostic quality within learning health systems.