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Original Investigation
Health Care Reform
September 13, 2010

Patient Perceptions of Mistakes in Ambulatory Care

Author Affiliations

Author Affiliations: Division of Geriatrics, Department of Medicine (Drs Kistler and Walter), University of California–San Francisco; and Cecil G. Sheps Center for Health Services Research (Ms Mitchell) and the Department of Family Medicine (Dr Sloane), The University of North Carolina at Chapel Hill. Dr Kistler is now affiliated with the Department of Family Medicine, The University of North Carolina at Chapel Hill.

Arch Intern Med. 2010;170(16):1480-1487. doi:10.1001/archinternmed.2010.288

Background  Little information exists about current patient perceptions of medical mistakes in ambulatory care within a diverse population. We aimed to learn about the perceptions of medical mistakes, what factors were associated with perceived mistakes, and whether the participants changed physicians because of these perceived mistakes.

Methods  We conducted a cross-sectional survey at 7 primary care practices in North Carolina of English- or Spanish-speaking adults, aged 18 years and older, who saw a health care professional during 2008. Main outcome measures were 4 questions about patient perceptions of medical mistakes in the ambulatory care setting, including (1) overall experience with a medical mistake; type of mistake, such as a (2) diagnostic mistake or (3) treatment mistake, and its associated harm; and (4) effect of this mistake on changing physicians.

Results  Of 1697 participants, 265 (15.6%) responded that a physician had made a mistake, 227 (13.4%) reported a wrong diagnosis, 212 (12.5%) reported a wrong treatment, and 239 (14.1%) reported having changed physicians because of a mistake. Participants perceived mistakes and harm in both diagnostic care and medical treatment. Patients with chronic back pain, higher educational attainment, and poor physical health were at increased odds of perceiving mistakes, whereas African American patients were less likely to perceive mistakes.

Conclusions  Patients perceived mistakes in their diagnostic and treatment care in the ambulatory setting. These perceptions had a concrete effect on the physician-patient relationship, often leading patients to seek another health care professional.