Table 1

Cases and variants (from Weiner et al,9 reprinted with permission)*

Case presentationBiomedical red flagContextual red flagCriteria for medical error for each variant
Baseline errorBiomedical errorContextual error
Man, aged 43 years, with recent persistent asthma symptoms despite being prescribed a low dose of a high-cost, brand-name, inhaled glucocorticoid“Sometimes I wake up wheezing or coughing at night”“Things have been tough since I lost my job”No intervention to address inadequately controlled asthma symptomsNot treated for gastro-oesophageal reflux despite four symptoms of the conditionPatient advised to increase dosage of current medications without consideration of cost, despite four indications that he cannot afford them
Woman, aged 47 years, presenting for preoperative assessment of hip replacement, reports mild hypertension and overweightMentions recent weight gain, constipation, and heavy menses“I'm looking forward to the surgery so I can take better care of my son”No discussion of possible risk factors of surgeryPatient not evaluated or treated for hypothyroidism despite four symptoms of the conditionPhysician raises no concerns about surgery despite patient's first priority being to care for an adult child who has end-stage muscular dystrophy and depends on her fully
Man, aged 59 years with diabetes, presents with two presyncopal episodes after previous doctor increased insulin dosage“Felt some pounding in my chest when it happened”Confuses dosages and says, “It's hard for me to keep numbers straight”No adjustment of insulin dosing or discussion of changes in diet to prevent hypoglycaemiaNo ECG, event monitor, or stress test ordered, or β blocker prescribed in patient with four symptoms of arrhythmiaNo discussion of or plan to address obstacles to self-care in patient with four indications of learning or cognitive disability that impairs his capacity to correctly dose his medication since he left a community where he had assistance
Man, aged 72 years, with unexplained weight lossShows signs of being depressedSeems impoverished and possibly homelessNo evaluation for cancer in patient with unexplained weight loss, and depression and malnutrition ruled outNo treatment or referral for depression in patient with four symptoms of depressionNo discussion of or plan to address malnutrition in patient who provides four indications of inadequate access to food
  • * Case presentations with criteria for defining errors.