Table 2.

Taxonomy of Patient Error

Level 1Level 2Level 3Type of ErrorParticipant Comment
a Groups are numbered according to Table 1.
Action errors
1. Attendance errors1.1 Underattendance1.1.1 NonattendanceRefusal of visits“If it runs through the family we seek no help” (group 2)
1.1.2 Insufficient attendanceLess frequent attendance than recommended“(Not) following your gut instinct and not seeking a second opinion” (group 8)
1.2 Untimely attendance1.2.1 Early attendanceAttendance for self-limiting conditions“Hypochondriacal behavior” (group 5)
1.2.2 Late attendanceDeferral of visit“Delay in visiting the doctor when you know you’re sick” (group 2)
1.3 Overattendance1.3.1 Frequent attendanceMore frequent attendance than required“Overattendance (eg, because the doctor is cute)” (group 2)
1.4 Misattendance1.4.1 Inappropriate type of visitDemand for a home visit by a patient who could have safely come to the clinicIrregularity (group 2)
1.4.2 No usual provider chosenFrequently changing providers“Consulting multiple doctors” (group 9)
1.4.3 Use of unqualified sourcesUse of unqualified complementary sourcesTaking advice from marginal sources: “over the fence, nonqualified practitioners, TV adverts” (group 9)
1.4.4. Refusals during visitsRefusal to be examined by a student doctor“Refusing to be checked by the doctor” (group 1)
1.4.5 No escort when neededNo interpreter“Not coming in with an interpreter (friend/relative) when their communication in English is suboptimal” (group 9)
1.4.6 Inappropriate escort/chaperoneChild“Not telling doctor what their real concerns are” (group 9)
2. Assertion errors2.1 Taciturnity2.1.1 Nondisclosure of relevant informationNot updating contact information“Not telling the doctor all your symptoms” (group 7)
2.1.2 NonquestioningNot asking for clarification of confusing information“Not questioning professionals if instructions are unclear or they do not understand” (group 10)
2.2 Verbosity2.2.1 Excessive talkNot giving the clinician sufficient time to meet concerns“Telling doctor what I want but not giving much time for him to tell me what he would like” (group 3)
2.3 Extraneous talk2.3.1 Irrelevant talkTrying too hard to recall details“No relationship with doctor, so just say ’yes‘ to everything” (group 1)
2.4 Erroneous talk2.4.1 Inaccurate talkContradicting medical advice to family or friends“Inaccurate/false responses” (group 2)
2.5 Inarticulateness2.5.1 Inability to express thoughts clearlyLimited language skills; translation errors.Inability to describe your sickness” (group 7)
2.6 Disrespect2.6.1 Lack of caringLack of regard for interests of clinician“Making 1 appointment for 2 to 4 people” (group 10)
2.6.2 DiscourtesyCell phone on during visits“Not notifying if late or, need to miss, appointments” (group 10)
2.6.3 AbusivenessViolent patient“Being drunk and abusive” (group 6)
2.7 Artfulness2.7.1 DishonestyDistortion of information given“Lying about symptoms to jump queue” (group 4)
2.7.2 Pretense of sicknessBenefits of sick role“Pretending to be ill to take the day off school” (group 7)
2.7.3 Manipulation of systemFalse claims for compensation“Seeks to manipulate the outflow of information from the medical record” (group 9)
3. Adherence errors3.1 Collection errors3.1.1 Prescriptions not redeemedPrescribed medications not collected from pharmacies“Only getting medications they can afford for now” (group 10)
3.2 Storage errors3.2.1 Storage errorsStorage of medications past expiration date“Accumulating discontinued medications” (group 9)
3.3 Self-administration3.3.1 No treatmentFailure to take recommended treatment“Running out of medications” (group 10)
3.3.2 Wrong treatmentTaking discontinued treatment“Using old medication” (group 6)
3.3.3 Dosage errorsExcessive dosage“Doubling up treatment if going away” (group 3)
3.3.4 Timing errorsTaking medication at incorrect times“Taking medication in wrong order” (group 11)
3.3.5 Duration errorsTreatment duration is shorter than recommended“Stopping too soon” (group 11)
3.3.6 Hazardous interactionsInteractions of over-the-counter and prescribed treatments“Mixing pills and alcohol” (group 6)
3.4 Other delivery errors3.4.1 Sharing of medicationSharing medication with family or friends“Sharing resources with relatives, eg, ‘rescue’ asthma inhalers” (group 10)
Mental errors: proximate determinants
4. Memory errors4.1 Memory lapses4.1.1 ForgetfulnessForgetting to take medication“Forgetting to collect the medication” (group 11)
4.1.2 Misrecalling informationMisrecalling when to attend for care“Turn up at wrong time” (group 1)
5. Mindfulness errors5.1 Inattention5.1.1 Failure to noticeNot perceiving“Not listening to what the doctor says” (group 8)
5.1.2 Recognize incorrectlyMisreading of symptoms“Over-reacting to children’s symptoms” (group 4)
5.2 Overattentiveness5.2.1 HypervigilanceOverattentiveness to variations in normal function“Hyperchondriacal behavior” (group 5)
6. Misjudgments6.1 Assessment errors6.1.1 Failure to checkFailure to check on laboratory results“Not checking pills from chemist” (group 3)
6.1.2 Failure to monitorFailure to monitor weight“Not monitoring blood glucose as recommended” (group 10)
6.1.3 Failure to recordFailure to keep a patient diary when requested“Not recording symptoms when asked, or bringing record back as asked” (group 9)
6.1.4 Wrong assessmentMisreading of instructions“Stopping medication just because you feel better” (group 1)
6.2 Unrealistic expectations6.2.1 Overexpectation of othersImmediate cure“Expecting the doctor to read their mind” (group 9)
6.2.2 Overexpectation of selfSelf-diagnosis“Using the Internet for self-diagnosis and self-treatment” (group 10)
6.2.3 Underexpectation of othersExpected inability of clinician to help“Having no faith in doctors” (group 8)
6.2.4 Underexpectation of selfExpected inability of self to cope or share responsibilities“Inability to cope with new presentations” (group 11)
Memory errors: background determinants
7. Knowledge deficits7.1 Knowledge errors7.1.1 Low literacyPoor language skills“Inability to read and understand instructions” (group 1)
7.1.2 Low health literacyNot knowing the name of medications“Confusion over brand, shape, color and name (especially when these change” (group 11)
7.1.3 Low numeracyInability to budget“Not budgeting and not having an emergency fund for medical care” (group 8)
7.2 Comprehension errors7.2.1 Lack of understandingFailure to understand instructions“Not understanding instructions (eg, re: casts, equipment)” (group 10)
7.3 Logic errors7.3.1 Reasoning errorsConsidering that a medication imparts absolute protection“Assuming that must be OK because feeling good” (group 2)
8. Attitudes not conducive to health8.1 Selfishness8.3.1 Excessive prideReluctance to ask for, or accept help“Reluctance to ask for help (eg, credit) because of pride” (group 8)
8.3.2 DishonestyLying“Lying about symptoms to jump queue” (group 4)
8.3.3 Self-pityFeeling a victim“Feeling self-pity; becoming a victim” (group 1)
8.3.4 HedonismWillingness to drink alcohol inappropriately“Taking medicines for recreational use (eg, too much insulin to get a high)” (group 11)
8.2 Self-neglect8.2.1 Excessive selflessnessCarriage of other people’s burdens“Putting other people’s needs first” (group 2)
8.2.2 Lack of self-regardShyness at visits“Forget to love oneself; putting other people before yourself” (group 4)
8.2.3 CarelessnessCarelessness“Losing instructions” (group 2)
8.2.4 EmbarrassmentShame“Not taking medications because you think your friends might mock you” (group 7)
8.3 Carelessness8.4.1 InattentionDistractedness or absent-mindedness“Patient distracted—not engaging in the consultation” (group 10)
8.4.2 Thoughtlessness regarding othersSharing food and drink while infectious“Not staying home when feeling sick (so spreading influenza)” (group 8)
8.4.3 Excessive risk taking“She’ll be OK” attitude“Taking risks with your health when sick” (group 5)
8.4.4 ApathyLaziness in getting medication“Noncollection of medicines because of sloth” (group 11)
8.4.5 UnreliabilityInconsistency in passing on messages“Inconsistent with medication” (group 3)
8.5 Distrust8.5.1 DisbeliefSuspicion of health professionals“Not believing the doctor” (group 2)
8.5.2 FearfulnessFear of needles“Staying with an unhelpful doctor because of familiarity and fear of change” (group 1)
8.5.3 UncooperativenessUnwillingness to negotiate“Refusing to be checked by the doctor” (group 1)
8.5.4 PessimismFeeling of helplessness“Giving up hope” (group 1)
8.6 Anger8.6.1 ImpatienceImpatience while waiting for care“Not having patience while waiting” (group 6)
8.6.2 IntolerancePrejudice against doctors with non-English speaking backgrounds“Stressing out on things that you have forgotten to do” (group 4)
8.7 Other priorities8.7.1 Cultural prioritiesMourning takes priority over medication adherence“Tangi [funeral] disrupts medical/health needs” (group 3)