{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:11:59Z","timestamp":1784049119038,"version":"3.55.0"},"reference-count":12,"publisher":"Walter de Gruyter GmbH","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Patient narratives are foundational to diagnosis, yet clinicians frequently and unintentionally distort, minimize, or reinterpret these narratives during clinical encounters. These distortions\u00a0\u2013\u00a0termed patient narrative distortion\u00a0\u2013\u00a0are unmeasured contributors to diagnostic error [G.D. Schiff, O. Hasan, S. Kim, R. Abrams, K. Cosby, B.L. Lambert et\u00a0al., Diagnostic error in medicine: analysis of 583\u00a0physician-reported errors, Arch Intern Med 169 (2009) 1881\u20131887; P. Croskerry, The importance of cognitive errors in diagnosis and strategies to minimize them, Acad Med 78 (2003) 775\u2013780; H. Singh, A.N.D. Meyer, E.J.\u00a0Thomas, The frequency of diagnostic errors in outpatient care, BMJ Qual Saf 23 (2014) 727\u2013731; and M.L. Graber, N. Franklin, R. Gordon, Diagnostic error in internal medicine, Arch Intern Med 165 (2005) 1493\u20131499], emotional harm [J.\u00a0Conway, F. Federico, K. Stewart, M.J.\u00a0Campbell, Respectful Management of Serious Clinical Adverse Events, IHI Innovation Series White\u00a0Paper, IHI, Cambridge, MA, 2011], and inequity [E.N. Chapman, A. Kaatz, M. Carnes, Physicians and implicit bias: how it affects clinical decision making, Acad Med 88 (2013) 354\u2013360; and M. Marmot, R.G. Wilkinson (Eds.), Social Determinants of Health, 2nd ed., Oxford University Press, Oxford, 2005]. No existing safety tool captures the fidelity with which clinicians preserve patient stories [T. Greenhalgh, B. Hurwitz (Eds.), Narrative Based Medicine: Dialogue and Discourse in Clinical Practice, BMJ Books, London, 1998; and W. Levinson, D.L. Roter, J.P. Mullooly, V.T. Dull, R.M. Frankel, Physician-patient communication: the relationship with malpractice claims, JAMA 277 (1997) 553\u2013559]. The stages at which narrative distortion emerges are illustrated in Figure\u00a01. The objective of this article was to define patient narrative distortion as a measurable construct, develop a five-domain taxonomy, propose a scoring system (PNDI), and outline a workflow and validation strategy for clinical\u00a0use.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted iterative conceptual modeling and structured synthesis of the diagnostic-safety and narrative-medicine literatures [G.D. Schiff, O. Hasan, S. Kim, R. Abrams, K. Cosby, B.L. Lambert et\u00a0al., Diagnostic error in medicine: analysis of 583\u00a0physician-reported errors, Arch Intern Med 169 (2009) 1881\u20131887; P. Croskerry, The importance of cognitive errors in diagnosis and strategies to minimize them, Acad Med 78 (2003) 775\u2013780; H. Singh, A.N.D. Meyer, E.J.\u00a0Thomas, The frequency of diagnostic errors in outpatient care, BMJ Qual Saf 23 (2014) 727\u2013731; and M.L. Graber, N. Franklin, R. Gordon, Diagnostic error in internal medicine, Arch Intern Med 165 (2005) 1493\u20131499] to identify core distortion modes, develop domain definitions, item-level anchors, and scoring thresholds. We propose a multi-phase validation plan including content validity, inter-rater reliability, construct validity, criterion validity, and responsiveness.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The PNDI taxonomy includes five domains: Narrative Completeness Distortion, Meaning Substitution Distortion, Salience Distortion, Context Stripping Distortion, and Bias-Driven Distortion [E.N. Chapman, A. Kaatz, M. Carnes, Physicians and implicit bias: how it affects clinical decision making, Acad Med 88 (2013) 354\u2013360]. Each domain includes 0\u20133 severity anchors and real-world clinical examples. The total PNDI score ranges from 0\u201315, with interpretation bands for narrative integrity and safety risk. Encounter-level, unit-level, and organizational-level workflows for implementation are outlined. The five-domain PNDI taxonomy is shown in Figure\u00a02.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n PNDI operationalizes narrative integrity as a measurable dimension of diagnostic safety [The Joint Commission, National Patient Safety Goals: Improving Diagnosis in Health Care 2024\u20132026, The Joint Commission, Oakbrook Terrace, IL, 2024]. It provides clinicians, educators, and safety teams with a practical tool to detect narrative loss, reduce diagnostic error [G.D. Schiff, O. Hasan, S. Kim, R. Abrams, K. Cosby, B.L. Lambert et\u00a0al., Diagnostic error in medicine: analysis of 583\u00a0physician-reported errors, Arch Intern Med 169 (2009) 1881\u20131887; P. Croskerry, The importance of cognitive errors in diagnosis and strategies to minimize them, Acad Med 78 (2003) 775\u2013780; H. Singh, A.N.D. Meyer, E.J.\u00a0Thomas, The frequency of diagnostic errors in outpatient care, BMJ Qual Saf 23 (2014) 727\u2013731; and M.L. Graber, N. Franklin, R. Gordon, Diagnostic error in internal medicine, Arch Intern Med 165 (2005) 1493\u20131499], and strengthen patient trust [W. Levinson, D.L. Roter, J.P. Mullooly, V.T. Dull, R.M. Frankel, Physician-patient communication: the relationship with malpractice claims, JAMA 277 (1997) 553\u2013559].<\/jats:p>\n <\/jats:sec>","DOI":"10.1515\/dx-2026-0086","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T16:33:14Z","timestamp":1784046794000},"source":"Crossref","is-referenced-by-count":0,"title":["The patient narrative distortion index (PNDI): a framework to detect narrative loss as a hidden driver of diagnostic error"],"prefix":"10.1515","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2635-3619","authenticated-orcid":false,"given":"Yogesh Kumar","family":"Gupta","sequence":"first","affiliation":[{"name":"Independent Researcher , East Brunswick , NJ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026071416330575596_j_dx-2026-0086_ref_008","unstructured":"Greenhalgh, T, Hurwitz, B, editors. 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