METHODS: This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors.
RESULTS: The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI: 10.8, 18.2). A total of 39.9% (95% CI: 33.1, 46.7) of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1) of records. Nearly all errors (93.5%) detected were considered preventable.
CONCLUSIONS: The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors.
CASE REPORT: A 21-year-old man who presented with chronic isolated bilateral pinna swelling as a result of leprosy is reported. The bilateral pinna swelling started as multiple shiny papules with an erythematous background and progressively became hyperpigmented and lobular over two years. This rare presentation of leprosy poses initial diagnostic difficulties, leading to misdiagnoses by various health care professionals. Diagnoses ascribed include eczema, insect bite and perichondritis. A suspicion of leprosy was raised when hyperaesthetic hypopigmentation of skin started to appear on the body after two years, with worsening of the pinna swellings. This was confirmed by identification of Mycobacterium leprae in slit skin smear test and skin biopsy.
CONCLUSION: Isolated involvement of pinna in a patient without lesions in other body parts is an unusual initial presentation of leprosy. However, leprosy should be kept as a rare differential diagnosis of isolated lesions on the ear in patients not responding to conventional treatment.
Aim: To report the rate of misdiagnosis and its associated risk factors in Malaysian children and adolescents with T1DM.
Methods: A retrospective analysis of children with T1DM below 18 years of age over a 10 year period was conducted.
Results: The cohort included 119 children (53.8% female) with a mean age 8.1 SD ± 3.9 years. 38.7% of cases were misdiagnosed, of which respiratory illnesses were the most common (37.0%) misdiagnosis. The rate of misdiagnosis remained the same over the 10 year period. Among the variables examined, younger age at presentation, DKA at presentation, healthcare professional (HCP) contact and admission to the intensive care unit were significantly different between the misdiagnosed and correctly diagnosed groups (p <0.05).
Conclusion: Misdiagnosis of T1DM occurs more frequently in Malaysian children <5 years of age. Misdiagnosed cases are at a higher risk of presenting in DKA with increased risk of ICU admission and more likely to have had prior HCP contact. Awareness of T1DM amongst healthcare professionals is crucial for early identification, prevention of DKA and reducing rates of misdiagnosis.
METHODS: A total of 88 final year medical students were assigned to either an educational intervention group or a control group in a non-equivalent group post-test only design. Participants in the intervention group received a tutorial on the use of a mnemonic checklist aimed to minimize cognitive errors in clinical decision-making. Two weeks later, the participants in both groups were given a script concordance test consisting of 10 cases, with 3 items per case, to assess their clinical decisions when additional data are given in the case scenarios.
RESULTS: The Mann-Whitney U-test performed on the total scores from both groups showed no statistical significance (U = 792, z = -1.408, p = 0.159). When comparisons were made for the first half and the second half of the SCT, it was found that participants in the intervention group performed significantly better than participants in the control group in the first half of the test, with median scores of 9.15 (IQR 8.00-10.28) vs. 8.18 (IQR 7.16-9.24) respectively, U = 642.5, z = -2.661, p = 0.008. No significant difference was found in the second half of the test, with the median score of 9.58 (IQR 8.90-10.56) vs. 9.81 (IQR 8.83-11.12) for the intervention group and control group respectively (U = 897.5, z = -0.524, p = 0.60).
CONCLUSION: Checklist use in differential diagnoses consideration did show some benefit. However, this benefit seems to have been traded off by the time and effort in using it. More research is needed to determine whether this benefit could be translated into clinical practice after repetitive use.