Table 1.

Factors that predispose to diagnostic errors in primary care settings

Factors	Ideal circumstances	Problems contributing to error
Access to high-quality primary care	Universal access without significant geographic, financial barriers	Limited access due to lack of money, remoteness, illiteracy, travel constraints or limited number of healthcare facilities
Availability of healthcare professionals	Sufficient range and number of healthcare professionals who contribute to the primary care team	Lack of sufficient healthcare professionals perhaps due to lack of training, outward migration or poor employment situation
Access to specialists	Specialists immediately available in person (or remotely through telemedicine) for expert assessment	Specialty expertise may not exist, or may be limited in number or quality
Diagnostic tests	Full range of appropriate diagnostic modalities (eg, imaging, laboratory tests) available when needed/appropriate	Diagnostic tests limited in scope, availability or quality as well as failure to interpret tests correctly
Communication	Patients and providers communicate efficiently; consultation and test results exchanged reliably and in timely fashion	Little or no sharing of medical information
Care coordination	Coordinated care facilitates available; accurate and efficient evaluation	Consultations are delayed; test results are lost, lack of health records to document care
Follow-up	Diagnosis enhanced by being able to follow symptom evolution; diagnostic errors are detected and errors ameliorated	Limited follow-up and discontinuities degrade the ability for diagnostic impressions to evolve
Affordability of care	All needed care is affordable and/or covered by insurance	Care unaffordable, or compromises other basic needs such as food or housing
Training of healthcare professionals	Physicians, nurses and all professional staff are well trained. Certification and licensure requirements ensure competency	Training is sub-optimal. Certification and licensure requirements are deficient
Availability of health informatics resources	Mature health informatics resources exist to support clinical care and decision-making	Health informatics resources including internet access not available especially in remote areas. Unaffordable subscription or download fees for medical information
Culture	Culture of safety exists; climate where clinicians not afraid to share and learn from mistakes. Patient-empowerment promoted, patients are partners in care	Traditional cultures often punitive, which discourages sharing and inhibits learning. Patients more passive care recipients