Factors that predispose to diagnostic errors in primary care settings
| Factors | Ideal circumstances | Problems contributing to error |
|---|---|---|
| Access to high-quality primary care | Universal access without significant geographic, financial barriers | Limited access due to lack of money, remoteness, illiteracy, travel constraints or limited number of healthcare facilities |
| Availability of healthcare professionals | Sufficient range and number of healthcare professionals who contribute to the primary care team | Lack of sufficient healthcare professionals perhaps due to lack of training, outward migration or poor employment situation |
| Access to specialists | Specialists immediately available in person (or remotely through telemedicine) for expert assessment | Specialty expertise may not exist, or may be limited in number or quality |
| Diagnostic tests | Full range of appropriate diagnostic modalities (eg, imaging, laboratory tests) available when needed/appropriate | Diagnostic tests limited in scope, availability or quality as well as failure to interpret tests correctly |
| Communication | Patients and providers communicate efficiently; consultation and test results exchanged reliably and in timely fashion | Little or no sharing of medical information |
| Care coordination | Coordinated care facilitates available; accurate and efficient evaluation | Consultations are delayed; test results are lost, lack of health records to document care |
| Follow-up | Diagnosis enhanced by being able to follow symptom evolution; diagnostic errors are detected and errors ameliorated | Limited follow-up and discontinuities degrade the ability for diagnostic impressions to evolve |
| Affordability of care | All needed care is affordable and/or covered by insurance | Care unaffordable, or compromises other basic needs such as food or housing |
| Training of healthcare professionals | Physicians, nurses and all professional staff are well trained. Certification and licensure requirements ensure competency | Training is sub-optimal. Certification and licensure requirements are deficient |
| Availability of health informatics resources | Mature health informatics resources exist to support clinical care and decision-making | Health informatics resources including internet access not available especially in remote areas. Unaffordable subscription or download fees for medical information |
| Culture | Culture of safety exists; climate where clinicians not afraid to share and learn from mistakes. Patient-empowerment promoted, patients are partners in care | Traditional cultures often punitive, which discourages sharing and inhibits learning. Patients more passive care recipients |