Table 4.

Patient‐Identified Diagnostic Safety Blindspots

	Number of Blindspots
Blindspot	N = 962 (%)	Examples
Events Occurring Outside the Visit	138 (14.3%)
Access		A family history was not correctly reported in a note, which affected ability to get an appointment with genetic counselors.
Tests and referrals		During my primary care office visit it was determined that I had a heart murmur and should have it followed up with an echo. My visit note did not mention it or say that a test should be planned. I pointed that out to the Dr. and he responded with a note correction.
		My results indicated that I did test positive for Chlamydia but I was told by my provider that I didn't (which was a mistake). If I didn't have these visit notes, I most likely would not have gotten the medication I needed.
		I was told my bone density test came back showing I had lost more bone mass, but based on the notes from two years prior, I saw I had actually GAINED bone mass.
		After a yearly physical, my PCP reported that I had no history of abnormal PAP smears. I had just had an abnormal pap 2 months prior and had to have a colposcopy. My PCP never asked about this at our appointment and must have just assumed there were no issues.
Multiple/Cascade	36 (3.7%)
>/ = 3 PRDBs		The HPI as written made little sense, reported that I had been hypothyroid when I had been hyperthyroid, reported that my symptoms were well controlled with current conservative therapy (which was untrue, and which is why I was seeking a second opinion), and failed to document an extra‐ocular movement exam, when one of my primary problems is double vision. In fact, as far as I could tell, there were no salient parts of an exam documented at all.
Omission	367 (38.1%)
Missing important symptoms/history, physical exam, or next steps		A doctor mentioned that I had NOT been febrile, when I mentioned that I had, and he said my lymph nodes were not enlarged, when he never palpated them.
		“[The] provider wrote that I did not have shortness of breath when I did indeed and had said so. It made me wonder if I had been misdiagnosed.
		[Note] said no diarrhea, which is not true. It is a big problem, I always complained about it. I recently found out I had IBS [Irritable Bowel Syndrome].
		I didn't tell the doctor I had had a hysterectomy. The notes said my uterus was normal. I called her office to correct that.
Not listening to patients		Doctors (plural) not recording my explanation of reason for visits completely accurate which makes a difference. Which means they weren't listening to me.
		I repeatedly (three times) asked the doctor what were the risks of my discontinuing treatment for my condition and he never answered me, but in the report states that he advised me of these risks and named them.
		When at a follow up visit and doctor asks question like: do you have discharge?
		I say yes but yet I read in my Chart notes where it is marked no. This frustrates me when they do not mark right answers. This will affect medical decisions made for me.
		Reported that I had gall bladder removed when I didn't and it was impossible to correct.
Diagnostic Misalignment	421 (43.8%)
Erroneous symptoms or history		It is mistake in regards to a certain type of migraine that I have. It stated clearly that I do not have migraine with aura. I in fact do have migraine with aura and that can create confusion that can alter another physician's perception of my situation later on particularly being that I am also epileptic.
		[The note] indicated that I had a metastasis from the wrong cancer episode. That mistake affected my current condition inaccurately.
		[The note said] I had post‐menopausal bleeding and that was what led doctors to find a uterine abnormality. The fact is that I never had post‐menopausal bleeding. A swelling in my leg led to searching for abdominal abnormalities and finding the one in my uterus.
		I was listed as having congestive heart failure, which was a surprise and untrue.
		Injury was at work so [it affected a] workman's company claim. Notes stated [the injury] happened elsewhere vs work so claim rejected. Have had to appeal, hire an attorney.
Wrong patient		Conditions have been listed that do not apply to me. Test results have been published for tests I never took! I have brought this to my PCP's attention and the appropriate changes were made.
		Someone else's notes were in my report, a different person with same name.
Breakdowns in diagnosis or next steps		The consulting surgeon…had not mentioned a rotator cuff tear in the right shoulder, which had undergone rotator cuff surgery in the past for adhesive capsulitis… when I went to P[hysical] T[herapy], expecting to receive help for serious rotator cuff pain, the therapist was completely unaware of the diagnosis. Eventually I was required to submit a written request for a correction to the visit notes, in order to have any level of attention paid to the shoulder. A lot of time went by and I was in considerable distress.
		Nurse practitioner prescribed antivirals for a rash she assumed to be a herpes (it wasn't). I never filled the prescription and the test came back negative for herpes, but the mistake was never corrected and the medication was (maybe still is?) listed as a medication I'm taking.