The situation is similar for molecular studies. Cytogenetic or fluorescence in situ hybridization results can serve as gold standards for certain disorders (eg, the classification of acute myeloid leukemia and certain lymphomas) however, cytogenetic criteria do not exist for most disorders encountered in routine surgical pathology. 2–4 Immunohistochemistry has similar problems and is subject to other reproducibility pitfalls stemming from the technique. Although some observers have more experience than others or are more competent than others, all observers are human and are subject to the problems of human fallibility that are well known to cognitive psychologists and to those who study error. Morphologic analysis, the cornerstone of anatomic pathology, cannot be considered a gold standard, because it is subjective and based on observer experience. Unfortunately, few scientifically validated gold standards exist in anatomic pathology. Accuracy reflects the truth, based on scientifically validated gold standards. Ideally, a correct result would be an accurate result. ERROR IN RELATION TO THE GOALS OF ANATOMIC PATHOLOGY The objectives of this article are to discuss what is meant by error in pathology, to suggest definitions that may be useful to the specialty of anatomic pathology, and to discuss where errors in anatomic pathology occur in relation to the classic laboratory test cycle. The definition of error in each specialty is not only important from the point of view of patient care but also is legally important, because for the legal profession error is usually equated with a deviation from generally recognized standards of care. Although the report generally defined error as a failure of a planned action to be completed as intended (an execution error) or the use of the wrong plan to achieve an aim (a planning failure), it did not refine the concept further for each specialty, leaving to each discipline the task of defining and quantifying those types of errors that are important or idiosyncratic to the specialty. The report broadly mandated a 50% reduction in medical errors across all specialties in the 5 years after its publication. Due in large part to the Institute of Medicine's 1999 report on medical error, 1 there is intense interest in reducing medical errors in all disciplines of medicine in the United States.
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