INTRODUCTION
There is increasing evidence that errors in diagnosis are relatively common in primary care and that the vast majority are preventable.1,2 The human and financial cost of diagnostic errors is significant, leading the World Health Organization to declare that reducing diagnostic errors in primary care should be considered a global priority, adding that, ‘Training focused on the causes and impact of diagnostic error might help providers become more competent in error prevention.’3
Although research has been published on how GPs perform diagnostic reasoning and on the causes of diagnostic errors in primary care, very little information is available on how to prevent or detect diagnostic errors.4–6 This article describes a mnemonic, SAFER AAA’S (Box 1), which can be used to both prevent and detect those diagnostic errors that are the most likely to cause serious harm to patients in the primary care setting.
| S = Have you excluded the serious, ‘must-not-miss’ diagnoses? |
| A = Have you considered the alternative, ‘must-always-consider’ diagnoses? |
| F = Have you checked for any findings that do not fit with your preliminary diagnosis, or fit better with a different diagnosis? |
| E = Have you considered that this could be an early/atypical presentation of something serious? |
| R = Have you checked for the red flags and risk factors for a serious illness or complication? |
| A = Have you assessed the patient and the quantity and quality of the information gathered? |
| A = Have you analysed the preliminary diagnosis, or only relied on pattern recognition? |
| A = Have you avoided a diagnostic reasoning malfunction or dysfunction? |
| S = Have you safety-netted the patient? |
SAFER AAA’S
THE MECHANICS OF DIAGNOSIS
The ‘mechanics of diagnosis’ is a simple concept to facilitate discussion about how a diagnosis is made and where errors can occur in the diagnostic process (Figure 1). In this model, establishing the correct diagnosis becomes a function of possessing the correct medical knowledge, gathering the correct information during the clinical assessment, and performing diagnostic reasoning correctly. Conversely, diagnostic errors occur when the correct medical knowledge is either not acquired, or not applied during the consultation; when the correct information is not gathered during the clinical assessment; or when diagnostic reasoning is not performed correctly. In primary care, patients present with a symptom, not a diagnosis, so it is important that a symptom-based, patient safety-focused approach …
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