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Diagnostic errors 'greatest threat to patient safety in hospitals,' claims senior doctor

Personal view: What is the main cause of avoidable harm to patients?

BMJ

Diagnostic errors are the most important causes of avoidable harm to patients in hospitals, warns a senior doctor on bmj.com today.

Dr Gordon Caldwell, a consultant physician at Worthing Hospital in Western Sussex argues that doctors need better facilities and sufficient time to make a correct diagnosis.

When a patient is admitted to hospital, the team of doctors formulate a "working diagnosis," he explains. At this point, the diagnosis is uncertain but the patient is treated as if the working diagnosis is correct.

"If over the next few days the patient gets better, the working diagnosis is confirmed and becomes the diagnosis," he says. However, if the patient does not improve, "we think again and consider whether the working diagnosis was wrong."

He warns: "The time taken to reach the correct diagnosis may critically impact on the patient's chances of survival. Over my career, I have seen many errors in the working diagnosis causing harm and even death to patients."

Little consideration seems to have been given to how doctors make and refine the working diagnosis and treatment plan for the patient, he adds. "We must allow clinicians enough time to be careful in diagnosis, treatment planning and treatment review."

Dr Caldwell believes that the profession has failed to let our patients and society know about this very important problem.

He concludes: "We must design our working spaces and information systems to maximise doctors' ability to see, understand, and deliberate on the information needed for more precise diagnosis. We must allow clinicians enough time to be careful in diagnosis, treatment planning, and treatment review. We must urgently consider how to provide rooms, time, and information for doctors to do the most difficult part of their job and the part most prone to error: the clinical thinking in making the working diagnosis and treatment plan."

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