Table 2.
Taxonomy of Patient Error
| Examplesa | ||||
| Level 1 | Level 2 | Level 3 | Type of Error | Participant Comment |
| Action errors | ||||
| 1. Attendance errors | 1.1 Underattendance | 1.1.1 Nonattendance | Refusal of visits | “If it runs through the family we seek no help” (group 2) |
| 1.1.2 Insufficient attendance | Less frequent attendance than recommended | “(Not) following your gut instinct and not seeking a second opinion” (group 8) | ||
| 1.2 Untimely attendance | 1.2.1 Early attendance | Attendance for self-limiting conditions | “Hypochondriacal behavior” (group 5) | |
| 1.2.2 Late attendance | Deferral of visit | “Delay in visiting the doctor when you know you’re sick” (group 2) | ||
| 1.3 Overattendance | 1.3.1 Frequent attendance | More frequent attendance than required | “Overattendance (eg, because the doctor is cute)” (group 2) | |
| 1.4 Misattendance | 1.4.1 Inappropriate type of visit | Demand for a home visit by a patient who could have safely come to the clinic | Irregularity (group 2) | |
| 1.4.2 No usual provider chosen | Frequently changing providers | “Consulting multiple doctors” (group 9) | ||
| 1.4.3 Use of unqualified sources | Use of unqualified complementary sources | Taking advice from marginal sources: “over the fence, nonqualified practitioners, TV adverts” (group 9) | ||
| 1.4.4. Refusals during visits | Refusal to be examined by a student doctor | “Refusing to be checked by the doctor” (group 1) | ||
| 1.4.5 No escort when needed | No interpreter | “Not coming in with an interpreter (friend/relative) when their communication in English is suboptimal” (group 9) | ||
| 1.4.6 Inappropriate escort/chaperone | Child | “Not telling doctor what their real concerns are” (group 9) | ||
| 2. Assertion errors | 2.1 Taciturnity | 2.1.1 Nondisclosure of relevant information | Not updating contact information | “Not telling the doctor all your symptoms” (group 7) |
| 2.1.2 Nonquestioning | Not asking for clarification of confusing information | “Not questioning professionals if instructions are unclear or they do not understand” (group 10) | ||
| 2.2 Verbosity | 2.2.1 Excessive talk | Not giving the clinician sufficient time to meet concerns | “Telling doctor what I want but not giving much time for him to tell me what he would like” (group 3) | |
| 2.3 Extraneous talk | 2.3.1 Irrelevant talk | Trying too hard to recall details | “No relationship with doctor, so just say ’yes‘ to everything” (group 1) | |
| 2.4 Erroneous talk | 2.4.1 Inaccurate talk | Contradicting medical advice to family or friends | “Inaccurate/false responses” (group 2) | |
| 2.5 Inarticulateness | 2.5.1 Inability to express thoughts clearly | Limited language skills; translation errors. | Inability to describe your sickness” (group 7) | |
| 2.6 Disrespect | 2.6.1 Lack of caring | Lack of regard for interests of clinician | “Making 1 appointment for 2 to 4 people” (group 10) | |
| 2.6.2 Discourtesy | Cell phone on during visits | “Not notifying if late or, need to miss, appointments” (group 10) | ||
| 2.6.3 Abusiveness | Violent patient | “Being drunk and abusive” (group 6) | ||
| 2.7 Artfulness | 2.7.1 Dishonesty | Distortion of information given | “Lying about symptoms to jump queue” (group 4) | |
| 2.7.2 Pretense of sickness | Benefits of sick role | “Pretending to be ill to take the day off school” (group 7) | ||
| 2.7.3 Manipulation of system | False claims for compensation | “Seeks to manipulate the outflow of information from the medical record” (group 9) | ||
| 3. Adherence errors | 3.1 Collection errors | 3.1.1 Prescriptions not redeemed | Prescribed medications not collected from pharmacies | “Only getting medications they can afford for now” (group 10) |
| 3.2 Storage errors | 3.2.1 Storage errors | Storage of medications past expiration date | “Accumulating discontinued medications” (group 9) | |
| 3.3 Self-administration | 3.3.1 No treatment | Failure to take recommended treatment | “Running out of medications” (group 10) | |
| 3.3.2 Wrong treatment | Taking discontinued treatment | “Using old medication” (group 6) | ||
| 3.3.3 Dosage errors | Excessive dosage | “Doubling up treatment if going away” (group 3) | ||
| 3.3.4 Timing errors | Taking medication at incorrect times | “Taking medication in wrong order” (group 11) | ||
| 3.3.5 Duration errors | Treatment duration is shorter than recommended | “Stopping too soon” (group 11) | ||
| 3.3.6 Hazardous interactions | Interactions of over-the-counter and prescribed treatments | “Mixing pills and alcohol” (group 6) | ||
| 3.4 Other delivery errors | 3.4.1 Sharing of medication | Sharing medication with family or friends | “Sharing resources with relatives, eg, ‘rescue’ asthma inhalers” (group 10) | |
| Mental errors: proximate determinants | ||||
| 4. Memory errors | 4.1 Memory lapses | 4.1.1 Forgetfulness | Forgetting to take medication | “Forgetting to collect the medication” (group 11) |
| 4.1.2 Misrecalling information | Misrecalling when to attend for care | “Turn up at wrong time” (group 1) | ||
| 5. Mindfulness errors | 5.1 Inattention | 5.1.1 Failure to notice | Not perceiving | “Not listening to what the doctor says” (group 8) |
| 5.1.2 Recognize incorrectly | Misreading of symptoms | “Over-reacting to children’s symptoms” (group 4) | ||
| 5.2 Overattentiveness | 5.2.1 Hypervigilance | Overattentiveness to variations in normal function | “Hyperchondriacal behavior” (group 5) | |
| 6. Misjudgments | 6.1 Assessment errors | 6.1.1 Failure to check | Failure to check on laboratory results | “Not checking pills from chemist” (group 3) |
| 6.1.2 Failure to monitor | Failure to monitor weight | “Not monitoring blood glucose as recommended” (group 10) | ||
| 6.1.3 Failure to record | Failure to keep a patient diary when requested | “Not recording symptoms when asked, or bringing record back as asked” (group 9) | ||
| 6.1.4 Wrong assessment | Misreading of instructions | “Stopping medication just because you feel better” (group 1) | ||
| 6.2 Unrealistic expectations | 6.2.1 Overexpectation of others | Immediate cure | “Expecting the doctor to read their mind” (group 9) | |
| 6.2.2 Overexpectation of self | Self-diagnosis | “Using the Internet for self-diagnosis and self-treatment” (group 10) | ||
| 6.2.3 Underexpectation of others | Expected inability of clinician to help | “Having no faith in doctors” (group 8) | ||
| 6.2.4 Underexpectation of self | Expected inability of self to cope or share responsibilities | “Inability to cope with new presentations” (group 11) | ||
| Memory errors: background determinants | ||||
| 7. Knowledge deficits | 7.1 Knowledge errors | 7.1.1 Low literacy | Poor language skills | “Inability to read and understand instructions” (group 1) |
| 7.1.2 Low health literacy | Not knowing the name of medications | “Confusion over brand, shape, color and name (especially when these change” (group 11) | ||
| 7.1.3 Low numeracy | Inability to budget | “Not budgeting and not having an emergency fund for medical care” (group 8) | ||
| 7.2 Comprehension errors | 7.2.1 Lack of understanding | Failure to understand instructions | “Not understanding instructions (eg, re: casts, equipment)” (group 10) | |
| 7.3 Logic errors | 7.3.1 Reasoning errors | Considering that a medication imparts absolute protection | “Assuming that must be OK because feeling good” (group 2) | |
| 8. Attitudes not conducive to health | 8.1 Selfishness | 8.3.1 Excessive pride | Reluctance to ask for, or accept help | “Reluctance to ask for help (eg, credit) because of pride” (group 8) |
| 8.3.2 Dishonesty | Lying | “Lying about symptoms to jump queue” (group 4) | ||
| 8.3.3 Self-pity | Feeling a victim | “Feeling self-pity; becoming a victim” (group 1) | ||
| 8.3.4 Hedonism | Willingness to drink alcohol inappropriately | “Taking medicines for recreational use (eg, too much insulin to get a high)” (group 11) | ||
| 8.2 Self-neglect | 8.2.1 Excessive selflessness | Carriage of other people’s burdens | “Putting other people’s needs first” (group 2) | |
| 8.2.2 Lack of self-regard | Shyness at visits | “Forget to love oneself; putting other people before yourself” (group 4) | ||
| 8.2.3 Carelessness | Carelessness | “Losing instructions” (group 2) | ||
| 8.2.4 Embarrassment | Shame | “Not taking medications because you think your friends might mock you” (group 7) | ||
| 8.3 Carelessness | 8.4.1 Inattention | Distractedness or absent-mindedness | “Patient distracted—not engaging in the consultation” (group 10) | |
| 8.4.2 Thoughtlessness regarding others | Sharing food and drink while infectious | “Not staying home when feeling sick (so spreading influenza)” (group 8) | ||
| 8.4.3 Excessive risk taking | “She’ll be OK” attitude | “Taking risks with your health when sick” (group 5) | ||
| 8.4.4 Apathy | Laziness in getting medication | “Noncollection of medicines because of sloth” (group 11) | ||
| 8.4.5 Unreliability | Inconsistency in passing on messages | “Inconsistent with medication” (group 3) | ||
| 8.5 Distrust | 8.5.1 Disbelief | Suspicion of health professionals | “Not believing the doctor” (group 2) | |
| 8.5.2 Fearfulness | Fear of needles | “Staying with an unhelpful doctor because of familiarity and fear of change” (group 1) | ||
| 8.5.3 Uncooperativeness | Unwillingness to negotiate | “Refusing to be checked by the doctor” (group 1) | ||
| 8.5.4 Pessimism | Feeling of helplessness | “Giving up hope” (group 1) | ||
| 8.6 Anger | 8.6.1 Impatience | Impatience while waiting for care | “Not having patience while waiting” (group 6) | |
| 8.6.2 Intolerance | Prejudice against doctors with non-English speaking backgrounds | “Stressing out on things that you have forgotten to do” (group 4) | ||
| 8.7 Other priorities | 8.7.1 Cultural priorities | Mourning takes priority over medication adherence | “Tangi [funeral] disrupts medical/health needs” (group 3) | |
a Groups are numbered according to Table 1 ▶.