Clinical research studyInadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes
Section snippets
Methods
We designed an 11-question, qualitative survey for physicians, who were asked to send us vignettes of known instances of oversights in physical examination and to answer related multiple choice questions. The study was approved by the Stanford University Institutional Review Board; the detailed instructions to the respondent and the questionnaire can be found online at www.surveymonkey.com/s/8S6DL7V.
A link to the questionnaire was sent to approximately 5000 physicians of diverse specialties
Results
Of the 263 responses received, 55 were excluded; of the 208 remaining responses, 27 were corrected by the criteria described in Methods.
Sixty-three percent of vignettes reported that the oversight was caused by a failure to perform the physical examination; 14% reported that the correct physical examination sign was elicited but misinterpreted. Eleven percent reported that the relevant sign was missed or not sought, and 12% reported “other” as the cause of the deficiency.
Consequence of the
Discussion
Recent publications describe the decline of physical examination skills.7, 8, 9, 10, 11, 12 Our study highlights the consequences and suggests that many adverse events are preventable. Our survey suggests that the major cause for error is simply that the examination is not performed.12, 13 In addition to diagnostic consequences, approximately half of the vignettes report treatment consequences. Most oversights pertained to a limited number of overlookers, suggesting that some errors may be
Acknowledgment
The authors thank Ralph Horwitz, MD, for his encouragement of the First Stanford Symposium on Bedside Medicine in 2009, and for his helpful discussions in planning this study.
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Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.