If I prescribe the wrong medication or the wrong dose, I can justify that by saying that we all make mistakes. But when it's a critique of your thinking as a diagnostician, that cuts to the core of who you are as a physician.
According to Trowbridge that is why diagnostic errors have received little attention in the patient safety movement despite the fact that they are believed to account for a large portion of adverse events. Patient safety leaders, as I've repeatedly observed before, have turned safety concerns into a culture of blame. This policy-level finger of blame, at least up to now, however, has pointed largely at system failures and unavoidable outcomes, areas for discussion well within the comfort zones of most docs. Not necessarily so when you move the conversation to misdiagnosis.
The problem of misdiagnosis is largely unexplored territory in the patient safety field. Transparency is essential if progress is to be made. To that end Trowbridge has helped set up an anonymous reporting system at his facility. It seems like a great idea to me although I would eliminate references to error partly for the reasons just stated, but also because of the difficulty on multiple levels of adjudicating misdiagnoses as to the presence or absence of error.
Solutions? Trobridge mentioned decision support, the effective use of basic clinical skills and an idea I particularly like, the “diagnostic time out.” It's exactly what DB was talking about here.