A review of diagnostic inaccuracy.

A review is presented of autopsy evidence demonstrating clinical diagnostic inaccuracy. Startling results emerge: the major clinical diagnosis is not confirmed in up to 45 per cent of cases, with typical error rates of up to 30 per cent; autopsy reveals unexpected major findings in up to 33 per cent of cases; management should have been different in up to 24 per cent of cases; clinicians cannot identify which patients are likely to have errant diagnoses; clinically 'certain' diagnoses still have a high error rate. These error rates have not changed significantly since an early study in 1912 despite the current widespread use of advanced investigation modalities.