Types of Medical Errors Commonly Reported by Family Physicians

One Pagers | Feb 15, 2003 Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

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.

Table. Five Most Commonly Reported Medical Errors in the United States and Five Other Countries

RankU.S. Family PhysiciansGeneral Practitioners in other Countries
Rank: 1U.S. Family Physicians: Errors in ordering medications (54 reports), especially prescribing contraindicated medicines or the wrong doseGeneral Practitioners in other Countries: Errors in ordering medications (57 reports), especially prescribing contraindicated medicines or the wrong medicine dose
Rank: 2U.S. Family Physicians: Errors in implementing laboratory investigations (27 reports), especially when requested lab test not done, lab performed wrong test, or abnormal lab test result not reported promptlyGeneral Practitioners in other Countries: Errors in communicating with patients about treatments (21 reports), especially failing to explain to patients how to take medications
Rank: 3U.S. Family Physicians: Filing system errors (25 reports), especially using the wrong file in the office visit or the report is lost (filed in wrong chart)General Practitioners in other Countries: Errors in ordering laboratory tests (16 reports), especially forgetting to order needed lab tests or providing incomplete information on lab request form
Rank: 4U.S. Family Physicians: Errors in implementing medication orders (24 reports), especially dispensing the wrong dose or drugGeneral Practitioners in other Countries: Errors in communicating between care providers in different settings (14 reports), especially not sending referral and discharge letters
Rank: 5U.S. Family Physicians: Errors in responding to abnormal laboratory test results (21 reports), especially failing to recognize abnormal results or failing to interpret lab results in the context of the clinical pictureGeneral Practitioners in other Countries: 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. However, 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.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP. 

Published in American Family Physician, Feb 15, 2003. Am Fam Physician. 2003;67(4):697. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.