Missed diagnosis of cancer in primary care: Insights from malpractice claims data

Cancer is a common but often challenging diagnosis in primary care, especially in patients presenting with nonspecific symptoms. Missed and delayed cancer diagnoses are common errors frequently associated with adverse clinical outcomes for patients, as well as contributors to malpractice risk in the primary care setting. Analysis of malpractice data has been highlighted as a potential strategy to help understand safety risks related to diagnostic errors and develop improvement strategies. This US study examined over 2000 closed diagnostic error malpractice claims in outpatient general medicine to identify key features associated with missed cancer diagnosis malpractice claims in primary care. The results showed that 46% of primary care diagnostic errors were missed cancer diagnoses (most commonly lung, colorectal, prostate, or breast cancer). The majority of these involved errors in clinical judgement – such as failure or delay in ordering a diagnostic test, or obtaining a consult or referral. These errors were associated with high-severity patient harm. These findings highlight the importance of preventing missed or delayed cancer diagnoses, and suggest more reliable systems for diagnostic testing and referrals are essential for patient safety in primary care.

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