Dedicated to the acceptance, medical treatment, & legal protection of individuals in the process of correcting the misalignment of their anatomical sex, & supporting their transition into society.
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Paris, France. How frequently do doctors misdiagnose patients? The issue of diagnostic error is rarely discussed and often understudied. While research has demonstrated that the great majority of medical diagnoses are correct, the answer is probably higher than patients expect and certainly higher than doctors realize. New research shows that errors ranged from <5% in the perceptual specialties (pathology, radiology, dermatology) up to 10% to 15% in many other fields.
In a Supplement to The American Journal of Medicine, a collection of articles and commentaries sheds light on the causes underlying misdiagnoses and demonstrates a nontrivial rate of diagnostic error.
Diagnostic Error: Is Overconfidence the Problem. Edited by Mark L. Graber MD, FACP, Eta S. Berner EdD, FACMI, FHIMSS. The American Journal of Medicine 121(5S) Supplement (May 2008).
The papers in this volume confirm the extent of diagnostic errors and suggest improvement will best come by developing systems to provide physicians with better feedback on their own errors.
Drs. Berner and Graber conducted an extensive literature review concerning teaching, learning, reasoning and decision making as they relate to diagnostic error and overconfidence and developed a framework for strategies to address the problem. They write,
Given that physicians overall are highly dedicated and well-intentioned, we believe that if they were more aware of these factors and their own predisposition to error, they would adopt behaviors and attitudes that would help decrease the likelihood of diagnostic error. ...
Being confident even when in error is an inherent human trait, and physicians are no exception. The fact that most of their diagnoses are correct, and that effective feedback regarding their errors is lacking, reinforces this inclination. When directly questioned, many clinicians find it inconceivable that their own error rate could be as high as the literature demonstrates. They acknowledge that diagnostic error exists, but believe the rate is very low, and that any errors are made by others who are less skillful or less careful. This reflects both overconfidence and complacency. ...
In medicine, the challenge is to reduce the complacency and overconfidence that leads to failure to recognize when one's diagnosis is incorrect.
Dr. Pat Croskerry and Dr. Geoff Norman review two modes of clinical reasoning to understand the processes underlying overconfidence. Ms. Beth Crandall and Dr. Robert L. Wears highlight gaps in knowledge about the nature of diagnostic problems, emphasizing the limitations of applying static models to the messy world of clinical practice.
In any endeavor, "Learning and feedback are inseparable," according to Dr. Gordon L. Schiff, who discusses the numerous barriers to adequate feedback and follow-up in the real world of clinical practice. Taking another approach, Dr. Jenny W. Rudolph and Dr. J. Bradley Morrison provide an expanded model of the fundamental feedback processes involved in diagnostic problem solving, highlighting particular leverage points for avoiding error. In the final commentary, Dr. Graber identifies stakeholders interested in medical diagnosis and provides recommendations to help each reduce diagnostic error.
These papers also emphasize a second theme. Medical practitioners really do not use systems designed to aid their diagnostic decision making. From early systems in the 1980s to more recent efforts, physicians have underutilized decision-support systems and misdiagnosis rates remain high.
I sympathize with and respectfully salute these present efforts to study diagnostic decision making and to remedy its weaknesses...
I applaud especially the suggestions to systematize the incorporation of the 'downstream' experiences and participation of the patients in all efforts to improve the diagnostic process.
"In my view, diagnostic error will be reduced only if physicians have a more realistic understanding of the amount of diagnostic errors they personally make," summarizes Paul Mongerson, who created a foundation to promote computer-based and other strategies to reduce diagnostic errors.
"I believe that the accuracy of diagnosis can be best improved by informing physicians of the extent of their own (not others) errors and urging them to personally take steps to reduce their own errors."
Many of the ideas expressed here emerged from discussions at a meeting among the authors in Naples, Florida, in December 2006 that was sponsored by the University of Alabama at Birmingham with support from the Paul Mongerson Foundation.
Diagnostic Error: Is Overconfidence the Problem. Edited by Mark L. Graber MD, FACP, Eta S. Berner EdD, FACMI, FHIMSS. The American Journal of Medicine 121(5S) Supplement (May 2008).
Foreword (by Paul Mongerson). After being misdiagnosed with pancreatic cancer in 1980, I founded the Computer Assisted Medical Diagnosis and Treatment Foundation to improve the accuracy of medical diagnosis. The foundation has sponsored programs to develop and evaluate computerized programs for medical diagnosis and to encourage physicians to use computers for their order entry. My role was insignificant, but as the result of much work by many people, substantial progress has been made. Physicians today are clearly more accepting of computer assistance and this movement is accelerating.
However, in 2006, I became worried after questioning my personal physicians as to why they did not use computers for diagnosis more often. Most explained that their diagnostic error rate was <1% and that computer use was time consuming. However, I had read that studies of diagnostic problem solving showed an error rate ranging from 5% to 10%. The physicians attributed the higher error rates to “other” less skilled physicians; few felt a need to improve their own diagnostic abilities.
From my perspective as a patient, even an error rate of 1% is unacceptable. It is ironic that most physicians I have asked are convinced there is much room for improvement in diagnosis—by other physicians. In my view, diagnostic error will be reduced only if physicians have a more realistic understanding of the amount of diagnostic errors they personally make. I believe that the accuracy of diagnosis can be best improved by informing physicians of the extent of their own (not others') errors and urging them to personally take steps to reduce their own mistakes.
It is logical that physicians' overconfidence in their ability inadvertently reduces the attention they give to reducing their own diagnostic errors. Unfortunately, this sensitive problem is rarely discussed and it is understudied. This supplement to The American Journal of Medicine, which features Drs. Eta S. Berner and Mark L. Graber's comprehensive review of a broad range of literature on the extent of diagnostic errors, the causes, and strategies to reduce them, addresses that gap.
Drs. Berner and Graber conducted the literature review and developed a framework for strategies to address the problem. Their colleagues' commentaries expand and refine our understanding of the causes of errors and the strategies to reduce them. The papers in this supplement confirm the extent of diagnostic errors and suggest improvement will best come by developing systems to provide physicians with better feedback on their own errors.
Hopefully this set of articles will inspire us to improve our own diagnostic accuracy and to develop systems that will provide diagnostic feedback to all physicians.
The TS-Si News Service is a collaborative effort by TS-Si.org editors, contributors, and corresponding institutions. The sources can include the cited individuals and organizations, as well as TS-Si.org staff contributions. Articles and news reports do not necessarily convey official positions of TS-Si, its partners, or affiliates.
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The TS-Si News Service is a collaborative effort by TS-Si.org editors, contributors, and corresponding institutions. The sources can include the cited individuals and organizations, as well as TS-Si.org staff contributions. Articles and news reports do not necessarily convey official positions of TS-Si, its partners, or affiliates. 
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