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Basic errors hurt patients

PHILADELPHIA -- Basic errors made by doctors, including tests ordered too late or not at all and failure to create follow-up plans, played a role in nearly 60 percent of cases in which patients were allegedly hurt by missed or delayed diagnoses, a study found.

Researchers in the study, published in the Annals of Internal Medicine yesterday, reviewed 307 closed medical malpractice claims, 181 of which allegedly involved diagnostic errors that harmed patients. Most of those cases involved various types of cancer.

While researchers acknowledged that most claims involved several factors, they said major ones included mistakes by doctors: failure to order appropriate diagnostic tests (100 cases); failure to create a proper follow-up plan (81); failure to obtain an adequate history or perform an adequate physical examination (76); and incorrect interpretation of tests (67).

Doctors not involved with the study said the findings highlight that physicians -- and patients -- need to err on the side of caution when it comes to ordering diagnostic tests, keeping detailed records, and executing a follow-up plan.

``It seemed like the bottom line was that the problems were problems that would occur less if a person was just very compulsive or very diligent," said Dr. Steven Sorscher, an oncologist at Washington University Medical School in St. Louis. ``It highlights the fact that the causes of serious errors are often preventable."

The study's lead author, Dr. Tejal K. Gandhi, director of patient safety at Brigham and Women's Hospital , said the research shows that doctors could use more help in making decisions.

Things that could assist doctors include more use of electronic records, better algorithms for making evaluations, and the use of nurse practitioners to help ensure that follow-ups actually occur, she said.

``I don't want to say that it's not the physician's responsibility," Gandhi said. ``We think there could be tools to help physicians make these decisions better."

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