More on Diagnostic Errors

Physician taking woman's blood pressure Today we’d like to follow-up on a recent post of ours that was quite popular that talked about how errors in diagnosis result in the largest med mal payouts. To give us some really good perspective on the topic, we went to AHRQ (Agency for Healthcare Research & Quality) and are diving into their Patient Safety Primer on Diagnostic Errors.

But first, for those of you who are really into this topic, and are local to the Chicago-area (or can travel on short-notice), you might want to check out the 6th International Conference: Diagnostic Error in Medicine being held in Chicago, Sept. 22-25, 2013. Sponsored by the Society to Improve Diagnosis in Medicine, their website was quite a find in researching this topic: they have many interesting pages on their site that are worth the view, including a “Facts” page about diagnostic errors in medicine,
a “Top Myths about Diagnostic Errors” page, and an excellent “Resources” page.

Now, back to the AHRQ Diagnostic Errors Primer. The document first describes physicians’ use of heuristics (or shortcuts or “rules of thumb”) and the several ways in which they can incorrectly apply heuristics (and arrive at a diagnostic error) –they refer to these as “cognitive biases.” More specifically, they describe 4 kinds of cognitive biases that physicians commonly display. So, in short, these are “physician” errors.

The primer then goes on to describe “system” problems and errors. Poor teamwork and communication, as well as lack of follow-up on test results, are examples that fall into this category.

The article then discusses ways to try and prevent diagnostic errors. Because many clinicians are unaware of their diagnostic errors, because they often don’t see patients post-diagnosis and/or over time, the AHRQ calls for more feedback to be given to physicians regarding their “diagnostic performance.” However, this is becoming more and more difficult, given that the “gold standard” of diagnosis, the autopsy, is becoming more and more rare. Teaching institutions are supposed to aspire for a 25% autopsy rate on inpatient deaths, but few, AHRQ says, achieve that.

IT has been helpful in some ways to curb system-based diagnostic errors –especially regarding giving timely test results. And, the development of protocols have helped to also reduce system errors, too.

And, some efforts have been undertaken to get physicians to think about their thinking –also known as meta-cognition. The thought is that if physicians can become aware of the ways in which they can possibly misuse heuristics, this will prevent some diagnostic errors.

Finally, the references listed at the end of the article are excellent should you want to do more reading on the topic.

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