Top 5 most frequent misdiagnoses in primary care: CMPA

From 2016 to 2020, the Canadian Medical Protective Association (CMPA) resolved 6,175 medico-legal cases involving family physicians delivering primary care, focusing on non-specialized services. Below is from the current CMPA’s Know Your Risk—data by clinical specialty report for family physicians. As of the end of 2021, 37,083 CMPA members were family medicine physicians. In addition to primary care, of course, some of these physicians provide specialized care including surgery, anesthesia, obstetrics, and shifts in the emergency department.First, top patient complaints for FPs. . . . Top 6 most common patient complaintsBetween 2016 and 2020, the CMPA closed 6,175 medico-legal cases involving family physicians providing primary care, i.e. non-specialized services. This CMPA report describes findings based on these medico-legal cases (civil legal actions, college complaints and hospital matters).The CMPA report notes: “Complaints are a reflection of the patient’s perception that a problem occurred during care. These complaints are not always supported by peer expert opinion. Peer experts may not be critical of the care provided, or may have criticisms that are not part of the patient complaint.”Top patient complaints for primary care: Deficient assessment (37%)Diagnostic errors (30%)Unprofessional manner (25%)Inadequate office procedures (21 %)Communication breakdown with patient (19%)Failure to perform test or intervention (17%)Read: Sask., Manitoba and Atlantic and Quebec see CMPA fees jump up5 most frequent misdiagnosesNow top five most frequent disdiagnoses. Diagnostic error is a significant challenge for primary care physicians. This report delves into 1,260 cases where peer experts identified diagnostic errors. Below are the patient conditions and their most common misdiagnoses:GI cancerIntestinal disordersNutritional anaemiasOther digestive system disordersBack disorderInjuries to lumbosacral areasSoft tissue disordersOther back disordersBreast cancerBenign neoplasmBreast disordersIschemic heart diseaseDigestive system disordersLower respiratory infectionsBack, nerve or joint disordersSecondary or ill-defined cancerMisdiagnosisThe CMPA notes: “A patient’s true condition can be mistaken for a variety of other conditions. For each condition, no single wrong diagnosis is predominant.”Top factors associated with severe patient harm for FPsPatient factorsWith underlying diagnosis of:Ischemic heart diseaseCancer of female genital organsArterial vascular disease, e.g. atherosclerosisCarcinoma in situComorbid condition of secondary cancerProvider factorsFailure to perform diagnostic test or interventionFailure to refer, admit or transfer patientInadequate monitoring or follow-upSystem factorsInadequate office policy or procedureTeam factorsPoor coordination of careInadequate handoverCommunication breakdown with other healthcare professionalsRisk reduction remindersHere are the risk reduction reminders in the CMPA’s Know Your Risk report for FPs: The following risk management strategies have been identified to help reduce diagnostic errors in primary care:Review all key elements of the patient’s medical record including earlier entries and referral notes. Pay attention to abnormal vital signs or physical findings.Actively consider what information supports the favoured diagnosis and what information does not fit, and thus minimize cognitive biases.Optimize office procedures forflagging abnormal results;generating a communication task to inform the patient of results;outlining the timeframe to communicate with patients who require urgent follow-up; andconfirming that patients have received messages and booked appropriate follow-up.Take a structured approach (e.g. SBAR, I-PASS) to communicating key information from the patient profile (e.g. medications, allergies, and patient wishes including advance directives and special exemptions) at patient handover and at every transition of patient care. Ensure important information is flagged during patient handover.Clearly define the roles and responsibilities of each team member to optimize care.For limitations on this report, the CMPA says: “CMPA medico-legal cases represent a small proportion of patient safety incidents overall. Many factors influence a person’s decision to pursue a case or file a complaint, and these factors vary greatly by context. Thus, while medico-legal cases can be a rich source for important themes, they cannot be considered representative of patient safety incidents overall.”

Top 5 most frequent misdiagnoses in primary care: CMPA

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