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

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

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