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New Study: Doctors Commonly Make Contextual Errors

Dr. Saul Weiner was testing an underweight, elderly man for cancer, a typical cause of extreme weight loss in the elderly. When Dr. Weiner asked the man where lived and if he ate regularly, his evasive answers lead Dr. Weiner to realize the man did not have cancer, but was homeless and starving.

Doctors often overlook social or economic circumstances when interacting with patients. These "contextual" issues are often relevant to the patient's medical condition and not recognizing the red flags can lead to medical errors such as misdiagnosis or an incorrect prescription.

Medical Errors

A report by the Institute of Medicine in 1999 found medical errors to be responsible for 45,000 to 98,000 deaths of Americans each year. Medical errors in hospitals are the eighth leading cause of death in the United States and those deaths that occur in hospitals cost the U.S. about $37.6 billion each year.

In 1999, the Massachusetts Board of Registration in Pharmacy estimated 2.4 million prescriptions were filled incorrectly in Massachusetts alone.

The Basics of the Medical Care Study

Dr. Weiner is an Associate Professor at the University of Illinois and a practicing physician at Jesse Brown Veterans Administration Medical Center. He is one of the doctors involved in a new study investigating contextual errors published in the Annals of Internal Medicine.

A group of actors posing as patients were sent to the offices of 111 physicians with carefully scripted lines. Four different scripts were used, one which hinted at a contextual complication, one which included a biomedical complication from a physical condition, another with both kinds of complications and a script with no alleged complications.

The study found that error-free care was given in only 22 percent of contextually complicated cases. Error-free care was given to 38 percent of cases with only biomedical complications.

Recognizing Contextual Issues

Some physicians claim that time restraints prevent them from being more thorough and asking questions of their patients. Others claim that they aren't properly trained in how to approach or help patients with social or economic problems.

Dr. Weiner recommends physicians receive better training in recognizing contextual issues and their effects on a patient's medical condition. He also recommends physicians to speak simply and listen carefully when interacting with patients to give the most complete medical care possible. The University of Illinois Medical School is creating a training program for students on avoiding contextual errors.

Related Resource: LA Times " 'Mystery Patients' Uncover Medical Errors

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