Friday, May 23, 2008

"Overconfidence as a cause of diagnostic error in medicine"

The May issue of the American Journal of Medicine is dedicated to the understanding and addressing the sensitive issue of diagnostic error. The authors of this particular article conducted an extensive literature review ( with more than 200 references) on the incidence and impact of diagnostic error and examined the possibility that overconfidence contributes to diagnostic error.

The authors noted that the rate of diagnostic error is as high as 15%, "when directly questioned, many clinicians acknowledge that diagnostic errors exist but believe the rate is very low and that any errors are made by others who are less skillful or less careful". The authrs said this reflects overconfidence and complacency that leads to the failure to recognise one's own error.

In the great majority of cases, most diagnosis are correct, but the authors said that very often diagnostic errors are cognitive in nature and arise from those cases that physicians perceive as routine and unchallenging. They failed to recognise the shortcomings that derive from heuristic thinking.

The authors found that many physicians underutilized diagnostic decision-making tools, eg guidelines, and that feedback regarding their errors is also lacking, together with the overconfidence, these have contributed to the high misdiagnosis rates.

Based on the belief that physicians overall are dedicated and well-intentioned, if they were more aware of these factors and their own predisposition to error, they would take steps to reduce their errors, the authors suggest that strategies to address the problem should focus on "improving the physician's calibration between their perception of the case and the actual case".

The authors suggest two approaches to reduce diagnostic error :
1). Improving physician's cognition needs and focusing on making them better thinkers, less subject to biases, and more aware of what they know and do not know.
2). Changing the healthcare environment so that the data on patients, potential diagnoses and any additional information are more accurate and accessible.

Source:"Overconfidence as a Cause of Diagnostic Error in Medicine" American Journal of Medicine 2008;121(5), supplement, S2-S23 (Free f/t)

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