Patient Perceptions of Medical Errors in Ambulatory Care

Studies on mistakes in medical care have largely focused on inpatient care, but there is evidence that patients perceive mistakes in their ambulatory care as well. The majority of the research on mistakes and errors in ambulatory care validates medical errors using incident reports or malpractice claims. According to researchers, this approach underestimates the prevalence of perceived mistakes; they recently conducted a survey to gather data on the perceptions of medical mistakes as well as learn what factors were associated with perceived mistakes, and whether the study participants changed physicians due to the perceived mistakes. Survey results were reported in Archives of Internal Medicine [2010;170(16):1480-1487]. The survey was conducted in 2008 in 7 primary care medical practices in North Carolina that are part of a practice-based research network. The practices were in geographically diverse settings: 1 was in a suburb, 2 were in towns, and 2 were in rural settings. There were 3 university-affiliated clinics, 2 community health centers, and 2 private practices. The cross-sectional survey was given to English- or Spanish-speaking adults ≥18 years of age who saw a healthcare provider during 2008. The researchers placed 1 or 2 trained research assistants in the waiting rooms of each practice for 15 days; they offered study participation to all adults who saw a physician, nurse practitioner, or physician assistant. The written survey was self-administered and was returned to the assistants at the clinic. Overall, 1754 patients were recruited for the survey, with a 63.9% recruitment rate of eligible patients; the current analysis involved 96.8% (n=1697) of patients who responded to the screening question on medical mistakes. The survey instrument included 4 questions about medical mistakes: (1) Has a doctor in a doctor’s office ever made a mistake in your care? (2) In the past 10 years, has a doctor in a doctor’s office made a wrong diagnosis or misdiagnosed you? (If yes, how much harm did this cause you?) (3) In the past 10 years, has a doctor in a doctor’s office given you the wrong medical treatment or delayed treatment? (If yes, how much harm did this cause you?) (4) Have you ever changed doctors because of either a wrong diagnosis or a wrong treatment of a medical condition? Harm was defined using a 5-point Likert scale: none, a little, some, a lot, or severe. Of the 1697 participants, 15.6% (n=265) said that a physician had made a mistake in their care, 13.4% (n=227) indicated a physician had made a wrong diagnosis, 12.5% (n=212) reported a wrong treatment, and 14.1% (n=239) said they had changed physicians because of a mistake. Of those who had experienced a mistake, 151 (approximately two thirds) said they had changed physicians. When asked about harm, the participants reported similar severity of perceived harm with no regard to the type of mistake. Of those who reported harm from a perceived mistake in diagnosis, 41.7% (n=91) reported a lot of or severe harm; of those who reported harm from a perceived mistake in treatment, 45.7% (n=95) reported a lot of or severe harm. Some patient characteristics were associated with increased odds of perceiving a mistake. Whites were more likely to report perceived mistakes than African Americans or Hispanics (19.6%, 13.1%, and 13.4%, respectively). The odds of perceiving a mistake were increased 2-fold by educational attainment beyond high school (P<.001). A self-report of chronic back pain was associated with a 1.5-fold increased odds of perceiving a mistake (P=.02). In summary, the researchers said “patients perceived mistakes in their diagnosis and treatment care in the ambulatory setting. These perceptions had a concrete effect on the physician–patient relationship, often leading patients to seek another healthcare professional.”