Therefore, it may be reasonable to consider the profuse rate of diagnostic error comprising the current state of clinical practice directly informs the legal definition of the “standard of care.” It is regularly noted the “standard of care” is not “perfect” care, but a much lower standard.⁶ Three cases, Hall v. Hilburn, Mc-Court v. Abernathy, and Johnston v. St. Francis Medical Center are cited as forming the general basis for the modern definition of “standard of care.” Relevant portions include:

“Our law says that a physician is not an insurer of health, and a physician is not required to guarantee results. He undertakes only to meet the standard of skill possessed generally by others practicing in his field under similar circumstances.” (Abernathy)

and

“When a physician undertakes to treat a patient, he takes on an obligation enforceable at law to use minimally sound medical judgment and render minimally competent care in the course of the services he provides.” (Hilbun)

Taken together, these opinions reinforce a standard associated with the skill of a “minimally competent” clinician. Relying upon these published estimates of the rate of diagnostic error, it would follow that error-prone practice is an unfortunate reality in modern medicine. A typical, reasonable, clinician providing “minimally competent care” will routinely make mistakes, and it is solely by virtue of good fortune and context by which the errors do not result in serious harms.

Patient safety and diagnostic errors research is critical to the design of a health system in which errors are minimized. With the advent of further decision-support and artificial intelligence-augmented medical care, potent tools exist to address the systemic barriers and cognitive biases that result in error. However, striving for ideal care is not incompatible with recognizing the challenges associated with diagnosis in our present complex medical ecosystem. These differing approaches to the problem of diagnostic error ought to both help us move forward, while also aiding a conversation regarding legally protecting physicians from the expectation of perfection.

Dr. Radecki (@emlitofnote) i s an emergency physician and informatician with Christchurch Hospital in Christchurch, New Zealand. He is the Annals of Emergency Medicine podcast co-host and Journal Club editor.

References

1. Newman-Toker DE, Peterson SM, Badihian S, et al. Diagnostic errors in the emergency department: a systematic review [internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Dec. (Comparative Effectiveness Review, No. 258.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK588118/
2. Newman-Toker DE, Nassery N, Schaffer AC, et al. Burden of serious harms from diagnostic error in the USA. BMJ Qual Saf. 2024;33(2):109-120. Published 2024 Jan 19.
3. Auerbach AD, Lee TM, Hubbard CC, et al. Diagnostic errors in hospitalized adults who died or were transferred to intensive care. JAMA Intern Med. 2024;184(2):164-173.
4. Kelen GD, Kaji AH; Consortium of societies of emergency medicine. the AHRQ report on diagnostic errors in the emergency department: the wrong answer to the wrong question. Ann Emerg Med. 2023;82(3):336-340.
5. Carpenter CR, Jotte R, Griffey RT, Schwarz E. A critical appraisal of AHRQ’s “diagnostic errors” report. Mo Med. 2023 Mar-Apr;120(2):114-120.
6. Moffett P, Moore G. The standard of care: legal history and definitions: the bad and good news. West J Emerg Med. 2011 Feb;12(1):109-12. PMID: 21691483.