Misdiagnoses

Misdiagnosis refers to a medical diagnosis that is incorrect, or a correct diagnosis that is delayed or missed at first. It encompasses cases where the initial diagnosis fails to identify the true condition, as well as situations in which symptoms or signs are attributed to the wrong disease or to benign causes. Misdiagnoses can occur in any area of medicine and may involve errors in history taking, examination, testing, interpretation of results, or communication between providers.

Common causes include cognitive factors such as anchoring, premature closure, and availability bias; systemic issues like fragmented care, poor handoffs, and limited access to timely testing; and patient factors such as atypical presentations or rare diseases. Inadequate follow-up, incomplete data, and misinterpretation of imaging or laboratory results also contribute. Misdiagnosis can be categorized as false positives, false negatives, partial diagnoses that omit relevant conditions, or missed altogether.

Consequences range from unnecessary treatments and adverse events to delayed correct care, progression of disease, increased costs, psychological distress, and medicolegal risk. Certain populations and settings may be at higher risk, including patients with complex presentations, those with uncommon diseases, and environments with high patient loads or poor communication.

Prevention and improvement efforts focus on enhancing diagnostic safety. Strategies include diagnostic checklists, second opinions, structured diagnostic timeouts, decision support tools, better information handoffs, longitudinal patient records, and active patient engagement. Education on cognitive biases and teamwork, junto with autopsy and case-review programs, can help identify and learn from missed diagnoses. Patients are encouraged to seek second opinions when symptoms persist or when uncertainty remains, and to communicate openly with clinicians about concerns.