Graham Center One-Pager

Types of Medical Errors Commonly Reported by Family Physicians

In a group of studies about medical errors in family medicine, the five error types most often observed and reported by U.S. family physicians were: (1) errors in prescribing medications; (2) errors in getting the right laboratory test done for the right patient at the right time; (3) filing system errors; (4) errors in dispensing medications; and (5) errors in responding to abnormal laboratory test results. "Errors in prescribing medications" was the only one of these five error types that was also commonly reported by family physicians in other countries.

Family practices are major health care providers for people in the United States. Compared with hospitals, family practices and other clinics in outpatient settings have been relatively exempt from scrutiny about the safety of their care. We need to know the types of preventable errors that happen in primary care settings so that we can launch appropriate and effective efforts to protect patients from the harm these errors may cause.

Before 2002, only one systematic investigation anywhere in the world had tried to list medical errors most commonly encountered by family physicians. A 1998 Australian study pointed to equipment malfunction, delayed or omitted treatment, missed or delayed diagnoses, and the use of inappropriate equipment as the most common and potentially harmful events affecting primary care patients. In 2000 and 2001, we collected reports from U.S. family physicians on their observations of things that went wrong in their practices. In 2001, general practitioners from Australia, Canada, England, the Netherlands, and New Zealand added their observations. The most common types of errors shown in the accompanying table come from a database of 416 error reports by U.S. family physicians and 356 reports from general practitioners in other countries.

Five Most Commonly Reported Medical Errors in the United States and Five Other Countries Rank U.S. family physicians General practitioners in other countries 1 Errors in ordering medications (54 reports), especially prescribing contraindicated medicines or the wrong dose Errors in ordering medications (57 reports), especially prescribing contraindicated medicines or the wrong dose 2 Errors in implementing laboratory investigations (27 reports),especially when requested laboratory test was not done, laboratory performed the wrong test, or abnormal laboratory test results were not reported promptly Errors in communicating with patients about treatments (21 reports), especially failing to explain to patients how to take medications 3 Filing system errors (25 reports), especially using the wrong file in the office visit or the report is lost (filed in the wrong chart) Errors in ordering laboratory tests (16 reports), especially forgetting to order needed laboratory tests or providing incomplete information on the laboratory request form 4 Errors in implementing medications orders (24 reports), especially dispensing the wrong dose or drug Errors in communicating between care providers in different settings (14 reports), especially not sending referral and discharge letters 5 Errors in responding to abnormal laboratory test results (21 reports), especially failing to recognize abnormal results, or failing to interpret laboratory results in the context of the clinical picture Wrong or delayed diagnosis (14 reports), especially failing to adequately examine patients

The numbers are small, the sample not random, and it is impossible to assess how environmental differences between countries might have affected the type of medical errors reported, but these data demonstrate: (1) that medication errors (especially related to prescribing decisions and dispensing) are probably widespread; (2) that current laboratory processes are error-prone; and (3) that other countries' family physicians do not commonly report the same sort of errors as family physicians in the United States, suggesting learning opportunities.

Adapted from Graham Center One-Pager #16. Dovey SM, Phillips RL, Green LA, Fryer GE. Types of medical errors commonly reported by family physicians. January 2003. Available at: www.aafppolicy.org/x394.xml. From the Robert Graham Center: Policy Studies in Family Practice and Primary Care, 1350 Connecticut Ave., NW, Suite 950, Washington, DC 20036 (telephone: 202-986-5708; fax: 202-986-7034; e-mail: policy@aafp.org).