Navigation Links
Will you be misdiagnosed? -- how diagnostic errors happen
Date:4/28/2008

New York, April 28, 2008 How frequently do doctors misdiagnose patients? While research has demonstrated that the great majority of medical diagnoses are correct, the answer is probably higher than patients expect and certainly higher than doctors realize. In a Supplement to the May issue of The American Journal of Medicine, a collection of articles and commentaries sheds light on the causes underlying misdiagnoses and demonstrates a nontrivial rate of diagnostic error that ranges from <5% in the perceptual specialties (pathology, radiology, dermatology) up to 10% to 15% in many other fields.

The sensitive issue of diagnostic error is rarely discussed and has been understudied. The papers in this volume confirm the extent of diagnostic errors and suggest improvement will best come by developing systems to provide physicians with better feedback on their own errors.

Guest Editors Mark L. Graber, MD, FACP (Veterans Affairs Medical Center, Northport, NY and Department of Medicine, SUNY Stony Book) and Eta S. Berner, EdD (School of Health Professions, University of Alabama at Birmingham) oversaw the development and compilation of these papers. Drs. Berner and Graber conducted an extensive literature review concerning teaching, learning, reasoning and decision making as they relate to diagnostic error and overconfidence and developed a framework for strategies to address the problem.

They write, Given that physicians overall are highly dedicated and well-intentioned, we believe that if they were more aware of these factors and their own predisposition to error, they would adopt behaviors and attitudes that would help decrease the likelihood of diagnostic error. Being confident even when in error is an inherent human trait, and physicians are no exception. The fact that most of their diagnoses are correct, and that effective feedback regarding their errors is lacking, reinforces this inclination. When directly questioned, many clinicians find it inconceivable that their own error rate could be as high as the literature demonstrates. They acknowledge that diagnostic error exists, but believe the rate is very low, and that any errors are made by others who are less skillful or less careful. This reflects both overconfidence and complacency. In medicine, the challenge is to reduce the complacency and overconfidence that leads to failure to recognize when ones diagnosis is incorrect.

Dr. Pat Croskerry and Dr. Geoff Norman review two modes of clinical reasoning to understand the processes underlying overconfidence. Ms. Beth Crandall and Dr. Robert L. Wears highlight gaps in knowledge about the nature of diagnostic problems, emphasizing the limitations of applying static models to the messy world of clinical practice.

In any endeavor, "Learning and feedback are inseparable," according to Dr. Gordon L. Schiff, who discusses the numerous barriers to adequate feedback and follow-up in the real world of clinical practice. Taking another approach, Dr. Jenny W. Rudolph and Dr. J. Bradley Morrison provide an expanded model of the fundamental feedback processes involved in diagnostic problem solving, highlighting particular leverage points for avoiding error. In the final commentary, Dr. Graber identifies stakeholders interested in medical diagnosis and provides recommendations to help each reduce diagnostic error.

These papers also emphasize a second theme. Medical practitioners really do not use systems designed to aid their diagnostic decision making. From early systems in the 1980s to more recent efforts, physicians have underutilized decision-support systems and misdiagnosis rates remain high.

Donald A.B. Lindberg, MD, Director of the National Library of Medicine, writes in an introduction to the Supplement, I sympathize with and respectfully salute these present efforts to study diagnostic decision making and to remedy its weaknessesI applaud especially the suggestions to systematize the incorporation of the downstream experiences and participation of the patients in all efforts to improve the diagnostic process.

In my view, diagnostic error will be reduced only if physicians have a more realistic understanding of the amount of diagnostic errors they PERSONALLY make, summarizes Paul Mongerson, who created a foundation to promote computer-based and other strategies to reduce diagnostic errors. I believe that the accuracy of diagnosis can be best improved by informing physicians of the extent of their own (not others) errors and urging them to personally take steps to reduce their own errors.


'/>"/>

Contact: Pamela Poppalardo
ajmmedia@elsevier.com
212-633-3944
Elsevier Health Sciences
Source:Eurekalert

Related medicine news :

1. Increase in Diagnostic Imaging Fueled by Self-Referring Doctors
2. Quest Diagnostics Reports Strong Revenue and Earnings Growth in First Quarter 2008
3. Innovative Diagnostic Instrument Introduced by Abbott for Low- to Mid-Volume Laboratory Market Segment
4. Allegro Diagnostics Announces Publication in Cancer Prevention Research of Prediction Model for Lung Cancer Diagnosis Integrating Clinical and Genomic Features
5. Quest Diagnostics to Release First Quarter 2008 Financial Results and Conduct Quarterly Investor Conference Call
6. Salivary diagnostics, the magic mirror to your health ... at your personal computer
7. Gen-Probe to Webcast Presentation at Leerink Swann Molecular Diagnostics Conference
8. Dominion Diagnostics Announces Launch of Comprehensive New Company Website
9. PET confirmed as valuable cancer diagnostic and disease-staging tool
10. FASgen Diagnostic Tests Identify Ovarian Cancer Progression and Apoptosis
11. BD to Present at the Leerink Swann Molecular Diagnostics Roundtable Conference
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... ... , ... Those who have experienced traumatic events may suffer from a complex ... as drug or alcohol abuse, as a coping mechanism. To avoid this pain and ... a traumatic event. , Trauma sufferers tend to feel a range of emotions, from ...
(Date:6/24/2016)... ... ... a crisis. Her son James, eight, was out of control. Prone to extreme mood shifts ... upset him, he couldn’t control his emotions,” remembers Marcy. “If there was a knife ... and say he was going to kill them. If we were driving on the ...
(Date:6/24/2016)... , ... June 24, 2016 , ... Global law firm ... 2016 Legal Elite. The attorneys chosen by their peers for this recognition are considered ... Seven Greenberg Traurig Shareholders received special honors as members of this year’s Legal Elite ...
(Date:6/24/2016)... ... June 24, 2016 , ... Comfort Keepers® of San ... Society and the Road To Recovery® program to drive cancer patients to and from ... adults to ensure the highest quality of life and ongoing independence. Getting to ...
(Date:6/24/2016)... ... June 24, 2016 , ... People across the U.S. are ... Code Talker Award, an essay contest in which patients and their families pay tribute ... presented at the 2016 National Society of Genetic Counselors (NSGC) Annual Education Conference (AEC) ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... , June 23, 2016 , ... Thursday, July 7, 2016 , , , , LOCATION: , ... , , , , EXPERT PANELISTS:  , , , Frost ... Industry Analyst, Christi Bird; Senior Industry Analyst, Divyaa Ravishankar and Unmesh ... The global pharmaceutical industry is witnessing an exceptional era. Several ...
(Date:6/23/2016)... , June 23, 2016  Astellas today announced the establishment of Astellas Farma Colombia (AFC), a new affiliate with ... Latin America . ... ... ... ...
(Date:6/23/2016)...  Guerbet announced today that it has been named ... . One of 12 suppliers to receive ... support of Premier members through exceptional local customer service ... to lower costs. ... outstanding customer service from Premier," says Massimo Carrara ...
Breaking Medicine Technology: