Diagnostics errors as the reasons for the discrepancy between clinical and pathoanatomical diagnoses

Abstract

Relevance. The development of medical science has made it easier for clinicians to diagnose specific diseases, often leading to the reduction of traditional diagnostic methods, including differential diagnosis. As a result, there is an increase in medical errors in diagnosis, the choice of treatment tactics, including in cases with the development of an unfavorable outcome. The aim of the study was to identify typical errors in the differential diagnosis of diseases in cases with a fatal outcome in the departments of both therapeutic and surgical profiles. Materials and Methods. At the first stage of the retrospective cohort study, fatal cases were analyzed for the correctness of the final post-mortem clinical diagnosis and the results of its comparison with the pathoanatomical diagnosis based on the results of the examination of the quality of medical care in compulsory health insurance. Errors in the formulation of the post-mortem clinical diagnosis were identified, and their causes were determined. At the second stage, the scenario method determines three variants of risk realization in the case of divergence of the final clinical and pathoanatomical diagnoses, with an assessment of the frequency of risk variants realization in the surgical and therapeutic profiles . Results and Discussion. When analyzing cases of fatal outcomes with a discrepancy between the final clinical and pathoanatomical diagnoses, the main errors in the formulation of the final clinical diagnosis were identified. In the first variant of risk realization, the reason for the discrepancy is the incorrect formulation of the final post-mortem diagnosis. In the case of the second scenario, violations relate to incorrect diagnostic tactics when a new disease or exacerbation of a chronic disease occurs. In the third scenario, violations are associated with incorrect differential diagnosis: the initial restriction of the range of nosologies for diagnostic search. Conclusion. Typical violations of diagnosis and differential diagnosis leading to a discrepancy between the final clinical and pathoanatomical diagnoses are identified. As part of the provision of medical care in surgical specialties, the second scenario is more often identified: incorrect diagnostic tactics when a new disease appears or a chronic disease worsens. When providing medical care in therapeutic specialties, violations are more often detected in the third scenario: incorrect differential diagnosis, initial restriction of the range of nosologies for diagnostic search. The second and third scenarios create legal risks for the doctor and the medical organization when evaluated by the relevant authorities.