BACKGROUND Experienced and anticipated regret influence physicians' decision-making. In medicine, diagnostic decisions and diagnostic errors can have a severe impact on both patients and physicians. Little empirical research exists on regret experienced by physicians when they make diagnostic decisions in primary care that later prove inappropriate or incorrect. The aim of this study was to explore the experience of regret following diagnostic decisions in primary care. METHODS In this qualitative study, we used an online questionnaire on a sample of German primary care physicians. We asked participants to report on cases in which the final diagnosis differed from their original opinion, and in which treatment was at the very least delayed, possibly resulting in harm to the patient. We asked about original and final diagnoses, illness trajectories, and the reactions of other physicians, patients and relatives. We used thematic analysis to assess the data, supported by MAXQDA 11 and Microsoft Excel 2016. RESULTS 29 GPs described one case each (14 female/15 male patients, aged 1.5-80 years, response rate < 1%). In 26 of 29 cases, the final diagnosis was more serious than the original diagnosis. In two cases, the diagnoses were equally serious, and in one case less serious. Clinical trajectories and the reactions of patients and relatives differed widely. Although only one third of cases involved preventable harm to patients, the vast majority (27 of 29) of physicians expressed deep feelings of regret. CONCLUSION Even if harm to patients is unavoidable, regret following diagnostic decisions can be devastating for clinicians, making them 'second victims'. Procedures and tools are needed to analyse cases involving undesirable diagnostic events, so that 'true' diagnostic errors, in which harm could have been prevented, can be distinguished from others. Further studies should also explore how physicians can be supported in dealing with such events in order to prevent them from practicing defensive medicine.

中文翻译：

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初级保健医生的遗憾：诊断决策调查。


背景技术经历过的和预期的后悔会影响医生的决策。在医学领域，诊断决策和诊断错误会对患者和医生产生严重影响。关于医生在初级保健中做出后来被证明不适当或不正确的诊断决定时所经历的后悔的实证研究很少。本研究的目的是探讨初级保健诊断决策后后悔的经历。方法 在这项定性研究中，我们对德国初级保健医生样本进行了在线调查问卷。我们要求参与者报告最终诊断与他们最初的意见不同的病例，以及至少延迟治疗并可能对患者造成伤害的病例。我们询问了最初和最终的诊断、疾病轨迹以及其他医生、患者和亲属的反应。我们使用主题分析来评估数据，并得到 MAXQDA 11 和 Microsoft Excel 2016 的支持。 结果 29 位全科医生各描述一个病例（14 名女性/15 名男性患者，年龄 1.5-80 岁，缓解率 < 1%）。 29例中有26例的最终诊断结果比最初的诊断更为严重。在两起案件中，诊断结果同样严重，在另一起案件中，诊断结果不那么严重。患者和亲属的临床轨迹和反应差异很大。尽管只有三分之一的案例涉及对患者造成可预防的伤害，但绝大多数（29 人中的 27 人）医生表达了深深的遗憾。结论 即使对患者的伤害不可避免，但诊断决定后的后悔对临床医生来说可能是毁灭性的，使他们成为“第二受害者”。 需要程序和工具来分析涉及不良诊断事件的案例，以便能够将“真正的”诊断错误与其他错误区分开来，其中伤害本可以避免。进一步的研究还应该探讨如何支持医生处理此类事件，以防止他们从事防御性医学。