Open Access Highly Accessed Research article

Medical errors in primary care clinics – a cross sectional study

Ee Ming Khoo1*, Wai Khew Lee2, Sondi Sararaks3, Azah Abdul Samad4, Su May Liew1, Ai Theng Cheong5, Mohd Yusof Ibrahim6, Sebrina HC Su3, Ainul Nadziha Mohd Hanafiah3, Kalsom Maskon7, Rohana Ismail8 and Maimunah A Hamid9

Author affiliations

1 Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, Kuala Lumpur, 50603, Malaysia

2 Luyang Health Clinic, Ministry of Health Malaysia, Off Jalan Lintas, Kota Kinabalu, Sabah, Malaysia

3 Department of Health Outcomes Research, Institute for Health Systems Research, Ministry of Health Malaysia, Jalan Rumah Sakit, Bangsar, Kuala Lumpur, Malaysia

4 Pantai Health Clinic, Ministry of Health Malaysia, Wisma Goshen, Plaza Pantai, Off Jalan Pantai Bharu, Kuala Lumpur, Malaysia

5 Department of Family Medicine, Universiti Putra Malaysia, Serdang, Malaysia

6 State Health Department of Sabah, Ministry of Health Malaysia, 3rd Floor, Federal Building, Jalan Mat Salleh, Kota Kinabalu, Sabah, Malaysia

7 Department of Medical Services, Medical Care Quality Section, Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia

8 Department of Public Health, Division of Family Health Development, Ministry of Health Malaysia, Putrajaya, Malaysia

9 Office of the Deputy Director General of Health (Research & Technical Support), Ministry of Health Malaysia, Level 12, Block E7, Parcel E, Federal Government Administrative Center, Putrajaya, Malaysia

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Citation and License

BMC Family Practice 2012, 13:127  doi:10.1186/1471-2296-13-127

Published: 26 December 2012



Patient safety is vital in patient care. There is a lack of studies on medical errors in primary care settings. The aim of the study is to determine the extent of diagnostic inaccuracies and management errors in public funded primary care clinics.


This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors.


The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI: 10.8, 18.2). A total of 39.9% (95% CI: 33.1, 46.7) of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1) of records. Nearly all errors (93.5%) detected were considered preventable.


The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors.

Medical errors; Diagnostic errors; Medication errors; Primary health care