Diagnostic Error In Medicine Research Articles

Understanding Diagnostic Errors: AJR Podcast Series on Diagnostic Excellence and Error, Episode 2.

In this episode of the AJR Podcast Series on Diagnostic Excellence and Error, Francis Deng, MD, and David Newman-Toker, MD, PhD, discuss prevalence and harms of diagnostic error in medicine, the role and causes of error in diagnostic radiology, and disease-specific examples, including in patients with stroke presenting with dizziness.

Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity.

Diagnostic errors in medicine represent a significant public health problem but continue to be challenging to measure accurately, reliably, and efficiently. The recently developed Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) approach measures misdiagnosis related harms using electronic health records or administrative claims data. The approach is clinically valid, methodologically sound, statistically robust, and operationally viable without the requirement for manual chart review. This paper clarifies aspects of the SPADE analysis to assure that researchers apply this method to yield valid results with a particular emphasis on defining appropriate comparator groups and analytical strategies for balancing differences between these groups. We discuss four distinct types of comparators (intra-group and inter-group for both look-back and look-forward analyses), detailing the rationale for choosing one over the other and inferences that can be drawn from these comparative analyses. Our aim is that these additional analytical practices will improve the validity of SPADE and related approaches to quantify diagnostic error in medicine.

The Diagnostic Error in Medicine 14th Annual International Conference.

The Diagnostic Error in Medicine 14th Annual International Conference.

The Diagnostic Error in Medicine 13th Annual International Conference.

The Diagnostic Error in Medicine 13th Annual International Conference.

New section: Diagnostic errors in medicine

New section: Diagnostic errors in medicine

Use of the Dual-Processing Theory to Develop Expert Clinical Reasoning in Physical Therapy Students

Background and Purpose. Cognitive error as a result of poor judgment accounts for a significant percentage of diagnostic errors in medicine. Use of judgment in the clinical setting can be described as clinical reasoning. Therefore, if educators of PT students intend to cultivate safe and effective practitioners, it is imperative to assist students in the development of effective judgment in addition to requisite knowledge and skills. Despite the importance, there are currently many limitations in clinical reasoning research in the field of physical therapy education. The purposes of this article are to introduce dual-processing theory as a means of conceptualizing clinical reasoning in physical therapy education and to provide recommendations for development of clinical reasoning. Position and Rationale. Clinical reasoning in physical therapy education lacks a unified theoretical framework from which to base instructional methods. It is the opinion of this author that in conjunction with an understanding of the development of expertise and expert performance, the dual-processing theory of reasoning provides an optimal foundation for clinical reasoning instruction and assessment. The dual-processing theory is underused despite being the prevailing theory to describe reasoning in health care providers. The dual-processing theory describes clinical reasoning as a balance between type I, intuitive, and type II, analytical processing. The final decision made is the result of the interaction between the two types of processing rather than sole reliance on analytical or intuitive thinking alone. This balance is how health care providers make decisions during the evaluation, examination, and treatment of patients. A key component in the ability to accurately manage the use of both types of processing is the awareness of the accuracy of thought processes. This awareness is also referred to as metacognition and is the necessary component of accurate clinical reasoning. Discussion and Conclusion. This position paper addresses one of the current limitations in clinical reasoning research in physical therapy by providing a theoretical rationale for use of the dual-processing theory in conceptualizing the components of clinical reasoning. PT students must cultivate an awareness of the accuracy of their thought processes in addition to acquiring deep-structure disciplinary knowledge. In accordance with the dual-processing theory as the theoretical framework for clinical reasoning, explicit teaching of accurate metacognitive self-monitoring in physical therapy education is integral to effective clinical reasoning.

Diagnostic Error in Medicine

Diagnostic Error in Medicine

Complexities of the Diagnostic Process.

The diagnostic process is a highly complex, problem-solving enterprise. Yet, traditional case reports have not focused directly on this endeavor. Physicians could use the case format to present actual experiences of getting to a diagnosis. This approach would allow for modeling of nonjudgmental, self-reflective practices and also provide information to aid in studying the diagnostic endeavor. Given that diagnostic errors in medicine are widespread and constitute a serious public health problem, it is crucial for physicians to understand the diagnostic process as one step toward improving error rates. This article uses clinical examples to illustrate and discuss the numerous areas of competence that are involved in coming to a diagnosis. The dual-process cognition model for understanding diagnostic decision making is introduced; the role of creativity is emphasized. Psychiatrists have important contributions to make in understanding the diagnostic process, given the field's long history of valuing self-reflection and conceptualizing clinician-patient dynamics.

Diagnostic Error in Medicine

Diagnostic Error in Medicine

To err is human: A case-based review of cognitive bias and its role in clinical decision making

To err is human: A case-based review of cognitive bias and its role in clinical decision making

Diagnostic error, overconfidence and self-knowledge

According to the overconfidence hypothesis (OH), physician overconfidence is a major factor contributing to diagnostic error in medicine. This article argues that OH can be read as offering a personal, a sub-personal or a systemic explanation of diagnostic error. It is argued that personal level overconfidence is an “epistemic vice”. The hypothesis that diagnostic errors due to overconfidence can be remedied by increasing physician self-knowledge is shown to be questionable. Some epistemic vices or cognitive biases, including overconfidence, are “stealthy” in the sense that they obstruct their own detection. Even if the barriers to self-knowledge can be overcome, some problematic traits are so deeply entrenched that even well-informed and motivated individuals might be unable to correct them. One such trait is overconfidence. Alternative approaches to “debiasing” are considered and it is argued that overconfidence is blameworthy only if it is understood as a personal level epistemic vice rather than a sub-personal cognitive bias. This paper is published as part of a collection on self-knowledge in and outside of illness.

Diagnostic Error in Medicine

Diagnostic Error in Medicine

The real malady of Marcel Proust and what it reveals about diagnostic errors in medicine

Marcel Proust, author of À La Recherche du Temps Perdu, was considered a hypochondriac not only by the numerous specialists he consulted during his lifetime but also by every literary critic who ventured an opinion on his health, among them several clinicians. However, Proust’s voluminous correspondence, as detailed in its attention to his every symptom as his novel, provides valuable clues to Proust’s real, organic, and rare illness. Proust, in fact, was not only genuinely ill but far sicker than he even he believed, most likely suffering from the vascular subtype of Ehlers–Danlos Syndrome. Ironically, Proust’s own doctors and his clinician-critics replicated the same kinds of diagnostic errors clinicians still routinely make today, shedding light on the plight of patients with rare illnesses.

Tapping into the wisdom in the room: results from participant discussion at the 7th International Conference on Diagnostic Error in Medicine facilitated by a World Café technique.

The patient safety literature is full of exhortations to approach medical error from a system perspective and seek multidisciplinary solutions from groups including clinicians, patients themselves, as well as experts outside the traditional medical domain. The 7th annual International Conference on Diagnostic Error in Medicine sought to attract a multispecialty audience, and attempted to capture some of the conversations by engaging participants in a World Café, a technique used to stimulate discussion and preserve insight gained during the conference. We present the ideas generated in this session, discuss them in the context of psychological safety, and demonstrate the application of this novel technique.

Психология диагностической ошибки

Diagnostic errors in medicine occur frequently and the consequences for the patient can be severe. Cognitive errors as well as system related errors contribute to the occurrence of diagnostic error, but it is generally accepted that cognitive errors are the main contributor. The diagnostic reasoning process in medicine, is an understudied area of research. One reason is because of the complexity of the diagnostic process and therefore the difficulty to measure diagnostic errors and the causes of diagnostic error. In this paper, I discuss some of the complexities of the diagnostic process. I describe the dual-process theory, which defines two reasoning modes, 1. a fast, automatic and unconscious reasoning mode called system 1, and a slow and analytic reasoning mode called system 2. Furthermore, the main cognitive causes of diagnostic error are described.

The critical step to reduce diagnostic errors in medicine: addressing the limitations of human information processing.

Over the last 50 years diagnostic testing has improved dramatically and we are now able to diagnose patients faster and more precisely than ever before. However, the incidence of diagnostic errors, particularly of common diseases, has remained relatively stable over time. In this paper, I argue that the intrinsic limitations of human information processing are crucial. The way people process information has not changed over the years and is the main cause of diagnostic error. To take a decisive step forward and substantially reduce the number of diagnostic errors in medicine, we need to create an environment which takes the intrinsic limitations of in human information processing into account.

Diagnostic errors in medicine: A critical role for diagnostic imaging in finding and facilitating solutions

Diagnostic errors in medicine: A critical role for diagnostic imaging in finding and facilitating solutions

Figure and ground in physician misdiagnosis: metacognition and diagnostic norms.

Meta-cognitive awareness, or self reflection informed by the "heuristics and biases" theory of how experts make cognitive errors, has been offered as a partial solution for diagnostic errors in medicine. I argue that this approach is not as easy nor as effective as one might hope. We should also promote mastery of the basic principles of diagnosis in medical school, continuing medical education, and routine reflection and review. While it may seem difficult to attend to both levels simultaneously, there is more to be gained from attending to both than from focusing only on one.

The incidence of diagnostic error in medicine

A wide variety of research studies suggest that breakdowns in the diagnostic process result in a staggering toll of harm and patient deaths. These include autopsy studies, case reviews, surveys...

Is Mindful Reflective Practice the way forward to reduce medication errors?

Medication errors can seriously affect patients and healthcare professionals. In over 60% of cases, medication errors are associated with one or more contributory; individual factors including staff being forgetful, stressed, tired or engaged in multiple tasks simultaneously, often alongside being distracted or interrupted. Routinised hospital practice can lead professionals to work in a state of mindlessness, where it is easy to be unaware of how both body and mind are functioning. Mindfulness, defined as moment-to-moment awareness of the everyday experience, could represent a useful strategy to improve reflection in pharmacy practice. The importance of reflection to reduce diagnostic errors in medicine has been supported in the literature; however, in pharmaceutical care, reflection has also only been discussed to a limited extent. There is expanding evidence on the effectiveness of mindfulness in the treatment of many mental and physical health problems in the general population, as well as its role in enhancing decision making, empathy and reducing burnout or fatigue in medical staff. Considering the benefits of mindfulness, the authors suggest that healthcare professionals should be encouraged to develop their practice of mindfulness. This would not only be beneficial in relieving stress, increasing attention levels and awareness, but it is believed that the integration of mindfulness and reflective practice in a 'Mindful Reflective Practice' could minimise some of the individual factors that lead to medication errors. Mindfulness Reflective Practice could therefore represent an important element in pre-registration education and continual professional development for pharmacists and other healthcare professionals.