The Practice of Medicine: Understanding Diagnostic Error

Risk of misdiagnosis and delayed diagnosis with COVID-19

“…When faced with a high volume of complex patients who require rapid assessment, clinicians may deal with time pressure by relying on mental shortcuts or cognitive strategies known as heuristics to facilitate decision-making. 2 , 22 - 24 While these are extremely useful for saving time, heuristics can also lead to cognitive biases. 2 , 22 - 24 When dealing with patients presenting with COVID-19 symptoms, clinicians may utilize common heuristics such as anchoring (locking onto first diagnosis), availability (focusing on common/recent diagnoses), and premature closure (accepting diagnosis before confirmation).…”

“…2 , 22 - 24 While these are extremely useful for saving time, heuristics can also lead to cognitive biases. 2 , 22 - 24 When dealing with patients presenting with COVID-19 symptoms, clinicians may utilize common heuristics such as anchoring (locking onto first diagnosis), availability (focusing on common/recent diagnoses), and premature closure (accepting diagnosis before confirmation). 20 , 22 For instance, when pressured for time, providers may be less likely to perform a comprehensive history and physical, which are critical to forming an adequate differential diagnosis.…”

“…After patients are engaged in care, experts recommend including them as active partners in the diagnostic process as an additional safety measure. 2 , 24 , 29 , 30 Empowering patients as allies can lead to improved symptom monitoring, tracking of diagnostic study results, and evaluating response to treatment. 2 , 29 , 30 This enables patients to become more proactive in advocating for their health, which is especially important during the pandemic when gaps in care are common and often lead to delayed diagnosis.…”

“…2 , 29 Practices are using teams of experts for developing informational call lines, diagnostic and treatment protocols, and computer templates with checklists and decision prompts to help providers manage patients with COVID-19-type symptoms. 2 , 24 , 29 Infectious disease, population health, and primary care experts collaborate on diagnostic algorithms, disease tracking, and outcome measures, all of which reduce a reliance on heuristics in diagnostic decision-making. 2 , 29 Nurses, social workers, and CHWs can assist with patient outreach, healthcare navigation, and linkage to resources to deal with socioeconomic stressors.…”

“… 29 Experts from relevant disciplines can also provide ongoing education through weekly meetings, mailings, and brief daily updates to help providers implement current guidelines for diagnosis and treatment. 24 , 29 Clinical huddles and case reviews offer an opportunity for providers to share both successes and failures that have occurred during the diagnostic process. Frequent and open communication is a means of building trust through transparency as well as a supportive environment for processing diagnostic errors as learning opportunities.…”