Problems related to patient-physician interactions were found in a majority of patient-reported diagnostic errors, according to the authors of a recent study.1

“Diagnostic errors are underreported, and patients’ unique perspectives are not well-incorporated in current patient safety and adverse event reporting mechanisms,” says Traber Davis Giardina, PhD, MSW, the study’s lead author.

Researchers analyzed a largely unexplored data source: What patients and families had to say about errors. Diagnostic error literature has, so far, focused mainly on clinician decision-making and healthcare system design.

“This effectively leaves out the patient experience. The patient voice is essential to highlight hidden factors that may contribute to diagnostic error,” says Giardina, a researcher at the Michael E. DeBakey Veteran Affairs Medical Center’s Center for Innovations in Quality, Effectiveness, and Safety.

These include patient-physician interactions that may not be captured via any other method. Giardina and colleagues analyzed 184 patient- or family-reported error narratives submitted from January 2010 to February 2016.

“We were interested in gaining a better understanding of patients’ and families’ experiences of diagnostic errors,” Giardina says.

The analysis identified 224 instances of behavioral and interpersonal factors that reflected unprofessional clinician behavior. These included ignoring patients’ knowledge, disrespecting patients, failing to communicate, and manipulation or deception. Giardina says this revelation was not too surprising.

“Patient advocates have been discussing this for some time,” she says. More intriguing was that patients associated the behaviors with unsafe care. “This highlights the importance of including and engaging patients in safety initiatives.”

Giardina says it is important for EDs and health systems to provide opportunities for patients, clinicians, and staff to easily report unprofessional behaviors without fear.

“The unprofessional behaviors outlined in our study are not being systematically collected, and there are not national guidelines or policies to do so,” Giardina laments.

Hardeep Singh, MD, MPH, another of the study’s authors, adds that the ED is a “high-risk environment as far as diagnosis and related patient-provider interaction is concerned.”

Patients usually present with undifferentiated symptoms. Generally, these patients are new to the ED provider. Additionally, data to make an accurate and timely diagnosis are not often easily available.

“The chaotic ED work environment is stressful for all parties. More often than not, providers are facing a lot of uncertainty in their diagnosis,” says Singh, chief of Health Policy, Quality & Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center.

For these reasons, effective patient-provider interactions are paramount in EDs. Singh says it is especially crucial for ED providers to carefully listen to patients’ concerns.

“Our prior research shows that poor data-gathering through history and exam is often a significant factor involved in certain types of diagnostic errors,” Singh notes.2

Singh believes the study’s findings send a strong message to ED providers. “There are many opportunities for improving patient-provider interactions and related communication to improve diagnosis-related outcomes,” he says.


  1. Giardina TD, Haskell H, Menon S, et al. Learning from patients’ experiences related to diagnostic errors is essential for progress in patient safety. Health Aff (Millwood) 2018;37:1821-1827.
  2. Medford-Davis L, Park E, Shlamovitz G, et al. Diagnostic errors related to acute abdominal pain in the emergency department. Emerg Med J 2016;33:253-259.