Predictors of Diagnostic Accuracy and Safe Management in Difficult Diagnostic Problems in Family Medicine

Kostopoulou, Olga; Oudhoff, Jurriaan P.; Nath, Radhika; Delaney, Brendan; Munro, Craig W; Harries, Clare; Holder, Roger

doi:10.1177/0272989x08319958

Cited by 52 publications

(48 citation statements)

References 39 publications

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“…14 -16 In practice, the most common cognitive error is premature closure of the diagnostic process, in which the physician may not even consider the correct diagnosis as a possibility. [17][18][19][20] For example, in a study of 583 diagnostic errors, Schiff and colleagues 18 found that "failure or delay in considering the diagnosis" was the most common failure in the diagnostic process. The most commonly missed diagnoses-cancer, pulmonary embolus, coronary disease, aneurysms, appendicitis-have been docu-mented in previous studies, 8,18,21,22 but little is known about the presenting complaints or initial (incorrect) diagnoses that precede these missed diagnoses.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Errors in Primary Care: Lessons Learned

Ely¹,

Kaldjian²,

D’Alessandro³

2012

The Journal of the American Board of Family Medicine

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Background: Diagnostic errors occur more commonly than other kinds of errors, they are more likely to harm patients, and they are more likely to be preventable. Little is known about the presenting complaints, initial (incorrect) diagnoses, and physicians' personal lessons learned related to diagnostic errors.Methods: In 2009 and 2010, we invited a random sample of 200 family physicians, 200 general internists, and 200 general pediatricians practicing in Iowa to describe an important diagnostic error using a 1-page, mailed questionnaire. The data were analyzed using quantitative and qualitative methods.Results: The response rate was 34% (202 of 600 physicians). Common presenting complaints included abdominal pain (n ‫؍‬ 27 of 202 patients, 13%); fever (n ‫؍‬ 19; 9%); and fatigue (n ‫؍‬ 15, 7%). Common initial (incorrect) diagnoses included benign viral infections (n ‫؍‬ 35, 17%); musculoskeletal pain (n ‫؍‬ 21, 10%); and chronic obstructive pulmonary disease/asthma (n ‫؍‬ 13, 6%). The 202 responding physicians described 254 personal lessons learned, which we used to develop a taxonomy of 24 generic lessons. Three common lessons were: (1) consider diagnosis X in patients presenting with symptom Y (n ‫؍‬ 37 lessons, 15%; eg, "Any discomfort above the umbilicus may be coronary artery disease."); (2) look beyond the initial, most obvious diagnosis (n ‫؍‬ 26 lessons, 10%); and (3) be alert to atypical presentations of disease (n ‫؍‬ 24 lessons, 9%).

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Section: Introductionmentioning

confidence: 99%

Diagnostic Errors in Primary Care: Lessons Learned

Ely¹,

Kaldjian²,

D’Alessandro³

2012

The Journal of the American Board of Family Medicine

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“…Kostopoulou and colleagues presented 84 family doctors with seven difficult computer-based diagnostic scenarios for which they could seek further information for diagnosis and management. Scoring criteria developed from literature and expert opinion showed that inappropriate management that could have been potentially harmful was planned in 78% of incorrectly diagnosed cases [7]. While this suggests that achieving a correct diagnosis is essential for safe patient care, the reality is that clinicians are often faced with presentations that require treatment when the diagnosis is uncertain or at best a guess.…”

Section: The Influence Of Case Management On Diagnostic Accuracymentioning

confidence: 99%

“…a set or sequence of actions to attain a diagnosis) into distinct stages [7,10,11]. Schiff et al [11] used the DEER taxonomy tool across 669 cases which involved 310 clinicians.…”

Section: Understanding Decision Making During the Diagnostic Process:mentioning

confidence: 99%

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Understanding diagnostic error: looking beyond diagnostic accuracy

Heyhoe

Lawton²,

Armitage

et al. 2015

Diagnosis

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Whether a diagnosis is correct or incorrect is often used to determine diagnostic performance despite there being no valid measure of diagnostic accuracy. In this paper we draw on our experience of conducting research on diagnostic error and discuss some of the challenges that a focus on accuracy brings to this field of research. In particular, we discuss whether diagnostic accuracy can be captured and what diagnostic accuracy does and does not tell us about diagnostic judgement. We draw on these points to argue that a focus on diagnostic accuracy may limit progress in this field and suggest that research which tries to understand more about the factors that influence decision making during the diagnostic process may be more useful in helping to improve diagnostic performance.

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“…However, I wonder whether this time limitation could potentially impact on the ability of primary care practitioner's to make complex diagnoses early, a potential 'achilles heel' of general practice, 2 thus adding to diagnostic delay and error, the biggest cause of medicolegal claims against GPs. 3 Recent research has shown that health systems with a gatekeeper function have lower cancer 1-year survival. 4 Around 23% of patients consult three or more times with a GP before suspected cancer referral, with increased repeat consultations in those from ethnic minorities and for certain cancers before referral.…”

Section: The Bjgpmentioning

confidence: 99%