Diagnosis errors: No easy fix
Physicians are responsible forone of the most complicated and important decisions in medicine: the diagnosis. Any further treatment plan rides on this diagnosis, and it may not be surprising that diagnosis error is now being looked at as a significant percentage of all medical errors. A report published in the November 9 Archives of Internal Medicine showed that anonymously, 310 physicians revealed 583 diagnosis errors, of which 44% were related to lab and radiology testing errors, including test ordering, test performance, and clinician processing.
But why do physicians make diagnosis errors? The answer lies in both cognitive processes and they systemic factors that influence the way in which a medical decision is made.
I co-wrote an article for HealthLeaders Media today about diagnosis error. The idea came from listening to one of theInstitute for Healthcare Improvement’s recent WIHI programs on the topic, which, if you haven’t listened in to yet this year, are truly worth catching. There is a great dialogue between the expert speakers and the audience because they address many of the questions that listeners bring up while virtually “chatting” with one another. Anyway, the WIHI featured Gordon Schiff, MD, associate director at the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital in Boston and Pat Croskerry, MD, PhD, professor in emergency medicine at Dalhousie University in Halifax, Nova Scotia. Both of these men are leaders in the field of diagnosis error and recently helped plan the second annual conference on the topic. Schiff is an author on the aforementioned Archives of Internal Medicine report.
Both men discussed that diagnosis errors occur more often than they are reported, and they have not been given as much attention to errors like medication errors, falls, and other tangible errors. This is because of the underreporting and also because it is harder to make the case that someone’s thinking was the cause of an error. In fact, diagnosis errors are partially the result of a cognitive impairment and partially the result of systemic failures—meaning the hospital system sets physicians up for failure.
I find the topic fascinating, what are your thoughts? The idea that people create certain thinking biases, often without even knowing it, and that that bias can factor into a decision that may determine the course of a patient’s treatment, even if it is the wrong treatment—it is a scary thought, but interesting nonetheless.
I suggest checking out the HealthLeaders article, please let me know of any feedback!
About the Author: Heather Comak is a Managing Editor at HCPro, Inc., where she is the editor of the monthly publication Briefings on Patient Safety, as well as patient safety-related books, webcasts, and audio conferences. She is also is the Assistant Director of the Association for Healthcare Accreditation Professionals (www.accreditationprofessional.com) and manages Patient Safety Monitor (www.patientsafetymonitor.com), of which this blog is a part.
Contact Heather by e-mailing hcomak@hcpro.com
Frederic Jones | Nov 11, 2009 | Reply
Jumping to Conclusions-A Serious Error in Diagnostic Reasoning.
Medicine is filled with little rules of thumb that describe diseases or the patients who get them; they are the shortcuts doctors use in their complex calculations en route to a diagnosis.
Once you get started down a diagnostic pathway, it becomes more difficult to go back to the starting point and find a new direction, even when the chosen path peters out. Jumping to the wrong conclusion, also referred to as premature closure, is one of many errors in diagnostic reasoning.
Others include errors of omission and incorrect and inadequate synthesis of information.
Premature closure occurs when clinicians fail to verify their initial hypothesis and yet fail to reject it.
Thus, the diagnosis is not adequately justified by the available data. Interestingly, of all the types of errors, premature closure appears to be the only one that occurs regardless of a clinician’s training and level of ability.
It is a particularly dangerous error to make in that it may lead to delayed or incorrect treatment.