Diagnostic mistakes

Other common types of adverse events in hospitals are preventable infections, surgical and diagnostic mistakes, and events involving equipment use. Two million patients are estimated to acquire infections in the hospital each year, and 25-70 percent of these infections are preventable 90,000 of the affected individuals die (Centers for Disease Control and Prevention, 1996 Weinstein, 1998 Haley and others, 1985). Between 87,500 and 350,000 patients are exposed to life-threatening infections every year because of hospital-acquired bloodstream infections alone (Wenzel and Edmond, 2001). 

A physician sees the patient of another physician and comes to believe that the first physician has made serious diagnostic mistakes and has treated the patient incompetently. She does not discuss her concerns with anyone. 

With regard to mistakes, two separate mechanisms operate. In the rule-based mode, an error of intention can arise if an incorrect diagnostic rule is used. For example, a worker who has considerable experience in operating a batch reactor may have learned diagnostic rules that are inappropriate for continuous process operations. If he or she attempts to apply these rules to evaluate the cause of a continuous process disturbance, a misdiagnosis could result, which could then lead to an inappropriate action. In other situations, there is a tendency to overuse diagnostic rules that have been successful in the past. 

The ability of melanomas to be labeled for bcl-1 protein and CDIO CD68 CD56, CD57, and CD99 and CD 117 creates the possibility that they may be confused with lymphomas, histiocytic lesions, primitive neuroectodermal and neuroendocrine neoplasms, and gastrointestinal stromal tumors, respectively. As usual, the application of carefully constructed panels of antibody reagents, tailored to specihc diagnostic scenarios, should preclude those mistakes. 

Autopsies showed for a quarter of all cases grave mistakes in diagnostics. 

The patient s skin condition, vehicles, concentration of test substance, volume of test material, test site, time and the number of readings influence the result. Mistakes are easily made. Textbooks on dermatology and contact dermatitis detail the technique and pitfalls. Hjorth (1977) published a comprehensive review of diagnostic patch testing. 

---